Urban environments have been identified as a non-point source contributor of nutrient loadings into watersheds. Interannual surges of nutrient loadings into local water systems are more damaging than mean interannual nutrient loadings. Virginia has outlined the need to reduce urban nutrient loadings. Mean interannual nutrient loadings and interannual nutrient loadings variability are expected to increase under climate change (CC). However, there are few studies that provide a predictive framework for abating nutrient loadings under CC. Thus, there is a lack of information regarding how effective water quality policy will be in the future. Using the Difficult Run watershed in Fairfax County, VA, as a site of study, we used mathematical programming to compare how the costs of abating nutrient loads differed under differing climates in the Mid-Atlantic. We first compared the costs of abating mean interannual nutrient loadings in the watershed based on historical climate conditions to those predicted for CC. We then evaluated how changes in the interannual variability of nutrient loadings for CC affect the costs of meeting watershed goals. We found that abating mean interannual nutrient loadings was substantially costlier for CC relative to meeting the same goals under historical climate conditions. Further, we found that the costs of abating interannual nutrient loadings variability increased under CC relative to meeting the same goals under historical climate. One implication of this study suggests that policy makers seeking to meet water quality goals over time must front-load supplemental BMPs today in order to offset the changes predicted for CC. / Master of Science

Med fokus på att öka lönsamheten för sina medlemmar strävar Norra Skog ständigt efter att förbättra och effektivisera sin logistik för att hantera det ständigt föränderliga flödet av massaved från skogsavlägg till industri. För att uppnå detta har företaget implementerat Woodflow, en avancerad programvara för logistikoptimering. I linje med det ökande intresset för att minska transportkostnader och främja hållbarhet inom transportnätverket, har det också börjat väcka intresse för att undersöka möjligheterna till att utöka användningen av tågtransporter för massaved. Detta examensarbete syftar till att analysera och optimera Norra Skogs transportflöde av massaved med målet att minimera transportkostnader och undersöka möjligheterna till att minska koldioxidutsläpp inom transportflödet. Arbetet inleddes med en grundlig litteraturstudie för att skapa en förståelse för leveranskedjan för massaved inom skogsindustrin samt ge en bakgrund till den optimeringsteori som ligger till grund för programvaran Woodflow.  Genom användning av Woodflow utfördes olika scenarioanalyser för att utvärdera olika strategier och metoder för att optimera transportflödet. Relevanta data för projektet samlades in och bearbetades för att förbereda indata till programvaran och möjliggöra analys av informationen om transportflöden för massaved. De undersökta scenarierna inkluderade ett scenario som speglade det faktiska transportflödet år 2023 och ett scenario med optimerade lastbilstransporter som användes som referenspunkt. Vidare genomfördes ett scenario med fria tåg- och lastbilstransporter med syftet att undersöka det optimala transportflödet som minimerar transportkostnader. Införande av nya terminaler och uteslutande av en befintlig terminal undersöktes i ett scenario och dessutom utfördes en analys av minimering av koldioxidutsläpp och transportkostnader genom att tillämpa en premiekostnad som representerade lastbilstransporternas högre koldioxidutsläpp. Till sist genomfördes ett framtidsscenario som syftar till att undersöka hur Norra Skog bör planera för sina transporter i framtiden utifrån prognoser av ökade tillgångsvolymer. Genom att noggrant utvärdera dessa olika scenarier söker arbetet efter de mest effektiva och hållbara lösningarna för Norra Skogs transportflöde för massaved. Resultatet visar på att det finns potential till stora kostnadsbesparingar och betydande minskningar av koldioxidutsläpp genom att optimera lastbilstransporterna från det faktiska utfallet 2023. Därefter finns ytterligare kostnadsbesparingar att hämta genom att optimera tågflödet och transportera mer volym via detta mer hållbara transportslag. Samtliga optimeringar av tågflödet, förutom framtidsscenariot med ökad tillgång, bidrar till ytterligare minskningar av koldioxidutsläpp och det anses därav vara av intresse för Norra Skog att fortsatt undersöka och utvärdera möjligheten att utöka tågtransporterna. Det är främst terminalen Storuman som visar på stor potential för fler antal tågavgångar, medan Hissmofors och Bastuträsk överlag visar minst potential för utökning av tågtransporter. Vidare visar terminalen Östavall ytterligare potential för ökad transport av massaved via tåg genom att helt ersätta terminalen Ånge. / Focusing on increasing profitability for its members, Norra Skog continuously strives to improve and streamline its logistics to manage the ever-changing flow of pulpwood from forest sites to industry. To achieve this, the company has implemented Woodflow, an advanced logistics optimization software. In line with the growing interest in reducing transportation costs and promoting sustainability within the transport network, there has also been increasing interest in exploring the possibilities of expanding the use of rail transport for pulpwood. This thesis aims to analyze and optimize Norra Skog's transport flow of pulpwood with the goal of minimizing transportation costs and exploring possibilities to reduce carbon dioxide emissions within the transport flow. The work began with a thorough literature review to create an understanding of the supply chain for pulpwood in the forestry industry and then provide a background to the optimization theory underlying the Woodflow software. Using Woodflow, various scenario analyses were conducted to evaluate different strategies and methods for optimizing the transport flow. Relevant data for the project was collected and processed to prepare input for the software and enable the analysis of information on pulpwood transport flows. The scenarios examined included one that reflected the actual transport flow in 2023 and one with optimized truck transports used as a reference point. Furthermore, a scenario with free rail and truck transports was conducted to investigate the optimal transport flow that minimizes transportation costs. The introduction of new terminals and the exclusion of an existing terminal were examined in one scenario, and an analysis of minimizing carbon dioxide emissions and transportation costs was also performed by applying a premium cost representing the higher carbon dioxide emissions of truck transports. Finally, a future scenario was conducted to examine how Norra Skog should plan its transports in the future based on forecasts of increased supply volumes. By carefully evaluating these different scenarios, the work seeks the most efficient and sustainable solutions for Norra Skog's pulpwood transport flow. The results show that there is potential for significant cost savings and substantial reductions in carbon dioxide emissions by optimizing truck transports from the actual outcome in 2023. Further cost savings can be achieved by optimizing the rail flow and transporting more volume with this more sustainable mode of transport. All optimizations of the rail flow, except for the future scenario with increased supply, contribute to further reductions in carbon dioxide emissions and are therefore considered of interest for Norra Skog to continue evaluating the possibility of expanding rail transports. It is mainly the terminal Storuman that shows great potential for an increased number of rail departures, while Hissmofors and Bastuträsk generally show the least potential for the expansion of rail transports. Furthermore, the Östavall terminal shows additional potential for increased transport of pulpwood by rail by completely replacing the Ånge terminal.

A Mucosite Oral é uma das principais e mais debilitantes complicações do Transplante de Medula Óssea. (Schubert et al., 1986; Borowski et al., 1994; Sonis, 1998; Peterson, 2004; Sonis, 2004; Scully, 2006; Sonis, 2009). Nessa terapia sua incidência varia entre 75-100%. (Wardley et al., 2000; Barasch; Peterson, 2003; Schubert et al., 2007; Blijlevens, 2008; Vokurka et al., 2009 ). A extensão e a severidade da Mucosite Oral estão significativamente correlacionadas com dias de narcótico injetável, alimentação parenteral, febre, risco de infecção importante, dias de hospitalização, custos hospitalares e mortalidade. (Sonis et al., 2001; Vera-Llonch et al., 2007). Nosso trabalho trata-se de um estudo de avaliação clínica e econômica, retrospectivo, de pacientes submetidos ao transplante de medula óssea no Hospital Israelita Albert Einstein, entre os anos de 2000 e 2008. Foram avaliados 167 pacientes, que foram divididos em dois grupos: Grupo I, composto por 91 pacientes que receberam atendimento odontológico e Laserterapia durante o TMO e Grupo II, composto por 76 pacientes que não receberam atendimento odontológico nem Laserterapia. Dados como idade, sexo, diagnóstico da doença de base, protocolo quimioterápico, tipo de transplante, uso de medicação para dor, dias de febre, utilização de alimentação parenteral, dias de internação, presença de infecção e grau de mucosite oral, com e sem atendimento odontológico, foram coletados e analisados. Uma análise descritiva, com base em tabelas de frequências e testes Qui-quadrado (ou exato de Fisher, quando este se mostrou mais apropriado), foi feita com o objetivo de verificar a associação estatística entre as variáveis de interesse. Estimativas dos riscos relativos, com intervalos de confiança de 95%, foram calculadas para avaliar a associação entre o desfecho (grau máximo) e as variáveis explicativas de interesse e o tempo médio de internação (em dias) nos diferentes grupos e tipos de transplantes foi comparado por meio de um modelo de análise de variância. Valores de p menores que 0,05 foram considerados como estatisticamente significantes. Pudemos concluir com esse trabalho que a extensão e a severidade da Mucosite Oral foram maiores no grupo sem atendimento Odontológico, sendo que o risco do paciente desse grupo apresentar grau III ou IV foi de 13 vezes maior que o grupo com Cirurgião-Dentista. Além disso, observamos que atendimento odontológico durante o TMO, quando praticado da forma descrita nesse estudo, é custo-efetivo, sendo capaz de reduzir as morbidades clínicas do TMO e que os benefícios do atendimento odontológico excederam os custos e, portanto, devem ser adotados. Foi constatado também que os pacientes que tiveram o acompanhamento do Cirurgião-Dentista apresentaram melhor qualidade de vida durante TMO e que o atendimento odontológico durante o TMO gerou economia para o hospital. / Oral mucositis is one of the main and most debilitating complications of Bone Marrow Transplants. In this therapy its incidence ranges between 75-100%. The extent and severity of Oral Mucositis are significantly correlated with the days of receiving injectable narcotics, parenteral feeding, fever, and risk of important infection, number of days of hospitalization, hospital costs and mortality. This study is a retrospective clinical and economic evaluation of patients submitted to bone marrow transplant at the \"Hospital Israelita Albert Einstein\", between the years 2000 and 2008. A total of 167 patients were evaluated, and were divided into two groups: Group I, composed of 91 patients who received dental treatment and Laser therapy during the BMT and Group II, composed of 76 patients who did not receive dental attendance or laser therapy. Data such as age, sex, diagnosis of the underlying disease, chemotherapy protocol, type of transplant, use of pain relief medication, days of fever, use of parenteral feeding, days of hospitalization, presence of infection and degree of oral mucositis, with and without dental attendance were collected and analyzed. A descriptive analysis, based on Frequency tables and Chi-square tests (or Fishers exact test, when this was shown to be more appropriate), was performed with the aim of verifying the statistical association among the variables of interest. Estimates of relative risks, with confidence intervals of 95% were calculated to evaluate the association between the outcome (maximum degree) and the explicative variables of interest and the mean time of hospitalization (in days) in the different groups and types of transplants was compared by means of an analysis of variance model. p- Values lower than 0.05 were considered statistically significant. By means of this study, it could be concluded that the extent and severity of Oral Mucositis were greater in the group without Dental attendance, as the risk of the patient in this group presenting Grade III or IV was 13 times higher than it was in the group attended by a Dentist. Moreover, it was observed that dental attendance during BMT, when performed in the manner described in this study, is cost-effective, as it is capable of reducing the clinical morbidities of BMT. Furthermore the benefits of dental attendance outweighed the costs, and therefore, must be adopted. It was also found that patients that were followed-up by the Dentist presented a better quality of life during BMT and that dental attendance during BMT resulted in savings for the hospital.

A Mucosite Oral é uma das principais e mais debilitantes complicações do Transplante de Medula Óssea. (Schubert et al., 1986; Borowski et al., 1994; Sonis, 1998; Peterson, 2004; Sonis, 2004; Scully, 2006; Sonis, 2009). Nessa terapia sua incidência varia entre 75-100%. (Wardley et al., 2000; Barasch; Peterson, 2003; Schubert et al., 2007; Blijlevens, 2008; Vokurka et al., 2009 ). A extensão e a severidade da Mucosite Oral estão significativamente correlacionadas com dias de narcótico injetável, alimentação parenteral, febre, risco de infecção importante, dias de hospitalização, custos hospitalares e mortalidade. (Sonis et al., 2001; Vera-Llonch et al., 2007). Nosso trabalho trata-se de um estudo de avaliação clínica e econômica, retrospectivo, de pacientes submetidos ao transplante de medula óssea no Hospital Israelita Albert Einstein, entre os anos de 2000 e 2008. Foram avaliados 167 pacientes, que foram divididos em dois grupos: Grupo I, composto por 91 pacientes que receberam atendimento odontológico e Laserterapia durante o TMO e Grupo II, composto por 76 pacientes que não receberam atendimento odontológico nem Laserterapia. Dados como idade, sexo, diagnóstico da doença de base, protocolo quimioterápico, tipo de transplante, uso de medicação para dor, dias de febre, utilização de alimentação parenteral, dias de internação, presença de infecção e grau de mucosite oral, com e sem atendimento odontológico, foram coletados e analisados. Uma análise descritiva, com base em tabelas de frequências e testes Qui-quadrado (ou exato de Fisher, quando este se mostrou mais apropriado), foi feita com o objetivo de verificar a associação estatística entre as variáveis de interesse. Estimativas dos riscos relativos, com intervalos de confiança de 95%, foram calculadas para avaliar a associação entre o desfecho (grau máximo) e as variáveis explicativas de interesse e o tempo médio de internação (em dias) nos diferentes grupos e tipos de transplantes foi comparado por meio de um modelo de análise de variância. Valores de p menores que 0,05 foram considerados como estatisticamente significantes. Pudemos concluir com esse trabalho que a extensão e a severidade da Mucosite Oral foram maiores no grupo sem atendimento Odontológico, sendo que o risco do paciente desse grupo apresentar grau III ou IV foi de 13 vezes maior que o grupo com Cirurgião-Dentista. Além disso, observamos que atendimento odontológico durante o TMO, quando praticado da forma descrita nesse estudo, é custo-efetivo, sendo capaz de reduzir as morbidades clínicas do TMO e que os benefícios do atendimento odontológico excederam os custos e, portanto, devem ser adotados. Foi constatado também que os pacientes que tiveram o acompanhamento do Cirurgião-Dentista apresentaram melhor qualidade de vida durante TMO e que o atendimento odontológico durante o TMO gerou economia para o hospital. / Oral mucositis is one of the main and most debilitating complications of Bone Marrow Transplants. In this therapy its incidence ranges between 75-100%. The extent and severity of Oral Mucositis are significantly correlated with the days of receiving injectable narcotics, parenteral feeding, fever, and risk of important infection, number of days of hospitalization, hospital costs and mortality. This study is a retrospective clinical and economic evaluation of patients submitted to bone marrow transplant at the \"Hospital Israelita Albert Einstein\", between the years 2000 and 2008. A total of 167 patients were evaluated, and were divided into two groups: Group I, composed of 91 patients who received dental treatment and Laser therapy during the BMT and Group II, composed of 76 patients who did not receive dental attendance or laser therapy. Data such as age, sex, diagnosis of the underlying disease, chemotherapy protocol, type of transplant, use of pain relief medication, days of fever, use of parenteral feeding, days of hospitalization, presence of infection and degree of oral mucositis, with and without dental attendance were collected and analyzed. A descriptive analysis, based on Frequency tables and Chi-square tests (or Fishers exact test, when this was shown to be more appropriate), was performed with the aim of verifying the statistical association among the variables of interest. Estimates of relative risks, with confidence intervals of 95% were calculated to evaluate the association between the outcome (maximum degree) and the explicative variables of interest and the mean time of hospitalization (in days) in the different groups and types of transplants was compared by means of an analysis of variance model. p- Values lower than 0.05 were considered statistically significant. By means of this study, it could be concluded that the extent and severity of Oral Mucositis were greater in the group without Dental attendance, as the risk of the patient in this group presenting Grade III or IV was 13 times higher than it was in the group attended by a Dentist. Moreover, it was observed that dental attendance during BMT, when performed in the manner described in this study, is cost-effective, as it is capable of reducing the clinical morbidities of BMT. Furthermore the benefits of dental attendance outweighed the costs, and therefore, must be adopted. It was also found that patients that were followed-up by the Dentist presented a better quality of life during BMT and that dental attendance during BMT resulted in savings for the hospital.

Au Canada, le cancer du poumon est la cause principale de décès relié au cancer. À l’imagerie médicale, le cancer du poumon peut prendre la forme d’un nodule pulmonaire. La prise en charge menant au diagnostic définitif d’un nodule pulmonaire peut s’avérer complexe. La recherche en oncoprotéomique a permis le développement de nouveaux tests diagnostiques non-invasifs en cancer du poumon. Ceux-ci ont pour objectif d’évaluer le risque de malignité d’un nodule pour guider la prise en charge menant au diagnostic. Toutefois, l’impact économique de tels tests demeure inconnu. L’objectif de ce projet était de mesurer, en milieu de pratique réelle, l’utilisation des ressources en soins de santé pour l’investigation de nodules pulmonaires puis, de développer un modèle générique permettant d’évaluer l’impact économique au Québec des nouveaux tests protéomiques pour l’investigation de ces nodules. Tout d’abord, une revue de dossiers patients a été effectuée dans trois centres hospitaliers du Québec afin de mesurer les ressources en soins de santé et les coûts associés à l’investigation de nodules pulmonaires entre 0,8 et 3,0 cm. Par la suite, une analyse de minimisation de coûts a été effectuée à partir d’un modèle générique développé dans le cadre de ce projet. Ce modèle visait à comparer l’approche courante d’investigation à celle intégrant un test protéomique fictif afin de déterminer l’approche la moins dispendieuse. La revue de dossiers patients a permis de déterminer qu’au Québec, le coût moyen d’investigation d’un nodule pulmonaire est de 7 354$. Selon les résultats de l’analyse, si le coût du test protéomique est fixé en-deçà de 3 228,70$, l’approche intégrant celui-ci serait moins dispendieuse que l’approche courante. La présente analyse suggère que l’utilisation d’un test diagnostique protéomique non-invasif en début d’investigation pour un nodule de 0,8 à 3,0 cm, permettrait d’engendrer des économies pour le système de santé au Québec. / In Canada, lung cancer is the leading cause of death among cancer patients. Imaging technologies, such as computed tomography, allows the detection of potential lung cancers in the form of pulmonary nodules. The clinical pathway leading to the definitive diagnostic of a pulmonary nodule can be complex. Research in oncoproteomics has led to the development of novel noninvasive diagnostic tests in lung cancer. These tests aim to evaluate the risk of malignancy of a nodule in order to guide the clinical pathway leading to a diagnostic. However, the economic impact of such tests remains unknown. The objective of this project was to measure, in a real-life setting, health care resource utilization for the investigation of pulmonary nodules and then, develop a generic model to assess the economic impact in the province of Quebec of new proteomic tests for the investigation of these nodules. Firstly, a medical chart review was performed in three hospitals in Quebec to measure health care resource utilization for the investigation of pulmonary nodules of 0,8 to 3,0 cm. Then, a cost minimization analysis was performed by using a generic model developed for this project. This model compared the usual care to the approach integrating a fictive proteomic test in order to identify the less expensive approach. As per the medical chart review, the average cost for the investigation of a pulmonary nodule was $7,354. According to the results of the analysis, if the cost of the test is below $3,228.70, the approach integrating a proteomic test would be less expensive then the current approach. This study tends to demonstrate that the use of a noninvasive proteomic diagnostic test at the beginning of the investigation of a pulmonary nodule from 0,8 to 3,0 cm could generate savings for the health care system in Quebec.

Les workflows sont des systèmes typiques traitant le big data. Ces systèmes sont déployés sur des sites géo-distribués pour exploiter des infrastructures cloud existantes et réaliser des expériences à grande échelle. Les données générées par de telles expériences sont considérables et stockées à plusieurs endroits pour être réutilisées. En effet, les systèmes workflow sont composés de tâches collaboratives, présentant de nouveaux besoins en terme de dépendance et d'échange de données intermédiaires pour leur traitement. Cela entraîne de nouveaux problèmes lors de la sélection de données distribuées et de ressources de stockage, de sorte que l'exécution des tâches ou du job s'effectue à temps et que l'utilisation des ressources soit rentable. Par conséquent, cette thèse aborde le problème de gestion des données hébergées dans des centres de données cloud en considérant les exigences des systèmes workflow qui les génèrent. Pour ce faire, le premier problème abordé dans cette thèse traite le comportement d'accès aux données intermédiaires des tâches qui sont exécutées dans un cluster MapReduce-Hadoop. Cette approche développe et explore le modèle de Markov qui utilise la localisation spatiale des blocs et analyse la séquentialité des fichiers spill à travers un modèle de prédiction. Deuxièmement, cette thèse traite le problème de placement de données intermédiaire dans un stockage cloud fédéré en minimisant le coût de stockage. A travers les mécanismes de fédération, nous proposons un algorithme exacte ILP afin d’assister plusieurs centres de données cloud hébergeant les données de dépendances en considérant chaque paire de fichiers. Enfin, un problème plus générique est abordé impliquant deux variantes du problème de placement lié aux dépendances divisibles et entières. L'objectif principal est de minimiser le coût opérationnel en fonction des besoins de dépendances inter et intra-job / The typical cloud big data systems are the workflow-based including MapReduce which has emerged as the paradigm of choice for developing large scale data intensive applications. Data generated by such systems are huge, valuable and stored at multiple geographical locations for reuse. Indeed, workflow systems, composed of jobs using collaborative task-based models, present new dependency and intermediate data exchange needs. This gives rise to new issues when selecting distributed data and storage resources so that the execution of tasks or job is on time, and resource usage-cost-efficient. Furthermore, the performance of the tasks processing is governed by the efficiency of the intermediate data management. In this thesis we tackle the problem of intermediate data management in cloud multi-datacenters by considering the requirements of the workflow applications generating them. For this aim, we design and develop models and algorithms for big data placement problem in the underlying geo-distributed cloud infrastructure so that the data management cost of these applications is minimized. The first addressed problem is the study of the intermediate data access behavior of tasks running in MapReduce-Hadoop cluster. Our approach develops and explores Markov model that uses spatial locality of intermediate data blocks and analyzes spill file sequentiality through a prediction algorithm. Secondly, this thesis deals with storage cost minimization of intermediate data placement in federated cloud storage. Through a federation mechanism, we propose an exact ILP algorithm to assist multiple cloud datacenters hosting the generated intermediate data dependencies of pair of files. The proposed algorithm takes into account scientific user requirements, data dependency and data size. Finally, a more generic problem is addressed in this thesis that involve two variants of the placement problem: splittable and unsplittable intermediate data dependencies. The main goal is to minimize the operational data cost according to inter and intra-job dependencies