Identificazione dei fenotipi clinici dell’insufficienza renale cronica che predicono la progressione della malattia. Un’applicazione della tecnica degli alberi decisionali

The primary aim of this dissertation to identify subgroups of patients with chronic kidney disease (CKD) who have a differential risk of progression of illness and the secondary aim is compare 2 equations to estimate the glomerular filtration rate (GFR). To this purpose, the PIRP (Prevention of Progressive Kidney Disease) registry was linked with the dialysis and mortality registries. The outcome of interest is the mean annual variation of GFR, estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. A decision tree model was used to subtype CKD patients, based on the non-parametric procedure CHAID (Chi-squared Automatic Interaction Detector). The independent variables of the model include gender, age, diabetes, hypertension, cardiac diseases, body mass index, baseline serum creatinine, haemoglobin, proteinuria, LDL cholesterol, tryglycerides, serum phoshates, glycemia, parathyroid hormone and uricemia. The decision tree model classified patients into 10 terminal nodes using 6 variables (gender, age, proteinuria, diabetes, serum phosphates and ischemic cardiac disease) that predict a differential progression of kidney disease. Specifically, age <=53 year, male gender, proteinuria, diabetes and serum phosphates >3.70 mg/dl predict a faster decrease of GFR, while ischemic cardiac disease predicts a slower decrease. The comparison between GFR estimates obtained using MDRD4 and CKD-EPI equations shows a high percentage agreement (>90%), with modest discrepancies for high and low age and serum creatinine levels. The study results underscore the need for a tight follow-up schedule in patients with age <53, and of patients aged 54 to 67 with diabetes, to try to slow down the progression of the disease. The result also emphasize the effective management of patients aged>67, in whom the estimated decrease in glomerular filtration rate corresponds with the physiological decrease observed in the absence of kidney disease, except for the subgroup of patients with proteinuria, in whom the GFR decline is more pronounced.

Spectral-Element and Adjoint 3D Full-Wave Tomography for the Lithosphere of Central Italy

The primary objective of this thesis is to obtain a better understanding of the 3D velocity structure of the lithosphere in central Italy. To this end, I adopted the Spectral-Element Method to perform accurate numerical simulations of the complex wavefields generated by the 2009 Mw 6.3 L’Aquila event and by its foreshocks and aftershocks together with some additional events within our target region. For the mainshock, the source was represented by a finite fault and different models for central Italy, both 1D and 3D, were tested. Surface topography, attenuation and Moho discontinuity were also accounted for. Three-component synthetic waveforms were compared to the corresponding recorded data. The results of these analyses show that 3D models, including all the known structural heterogeneities in the region, are essential to accurately reproduce waveform propagation. They allow to capture features of the seismograms, mainly related to topography or to low wavespeed areas, and, combined with a finite fault model, result into a favorable match between data and synthetics for frequencies up to ~0.5 Hz. We also obtained peak ground velocity maps, that provide valuable information for seismic hazard assessment. The remaining differences between data and synthetics led us to take advantage of SEM combined with an adjoint method to iteratively improve the available 3D structure model for central Italy. A total of 63 events and 52 stations in the region were considered. We performed five iterations of the tomographic inversion, by calculating the misfit function gradient - necessary for the model update - from adjoint sensitivity kernels, constructed using only two simulations for each event. Our last updated model features a reduced traveltime misfit function and improved agreement between data and synthetics, although further iterations, as well as refined source solutions, are necessary to obtain a new reference 3D model for central Italy tomography.

Three dimensional seismic imaging and earthquake locations in a complex, segmented fault region in Southern Apennines (Italy)

The southern Apennines of Italy have been experienced several destructive earthquakes both in historic and recent times. The present day seismicity, characterized by small-to-moderate magnitude earthquakes, was used like a probe to obatin a deeper knowledge of the fault structures where the largest earthquakes occurred in the past. With the aim to infer a three dimensional seismic image both the problem of data quality and the selection of a reliable and robust tomographic inversion strategy have been faced. The data quality has been obtained to develop optimized procedures for the measurements of P- and S-wave arrival times, through the use of polarization filtering and to the application of a refined re-picking technique based on cross-correlation of waveforms. A technique of iterative tomographic inversion, linearized, damped combined with a strategy of multiscale inversion type has been adopted. The retrieved P-wave velocity model indicates the presence of a strong velocity variation along a direction orthogonal to the Apenninic chain. This variation defines two domains which are characterized by a relatively low and high velocity values. From the comparison between the inferred P-wave velocity model with a portion of a structural section available in literature, the high velocity body was correlated with the Apulia carbonatic platforms whereas the low velocity bodies was associated to the basinal deposits. The deduced Vp/Vs ratio shows that the ratio is lower than 1.8 in the shallower part of the model, while for depths ranging between 5 km and 12 km the ratio increases up to 2.1 in correspondence to the area of higher seismicity. This confirms that areas characterized by higher values are more prone to generate earthquakes as a response to the presence of fluids and higher pore-pressures.

Fault delineation and stress orientations from the analysis of background, low magnitude seismicity in Southern Apennines (Italy)

The aim of this work was to show that refined analyses of background, low magnitude seismicity allow to delineate the main active faults and to accurately estimate the directions of the regional tectonic stress that characterize the Southern Apennines (Italy), a structurally complex area with high seismic potential. Thanks the presence in the area of an integrated dense and wide dynamic network, was possible to analyzed an high quality microearthquake data-set consisting of 1312 events that occurred from August 2005 to April 2011 by integrating the data recorded at 42 seismic stations of various networks. The refined seismicity location and focal mechanisms well delineate a system of NW-SE striking normal faults along the Apenninic chain and an approximately E-W oriented, strike-slip fault, transversely cutting the belt. The seismicity along the chain does not occur on a single fault but in a volume, delimited by the faults activated during the 1980 Irpinia M 6.9 earthquake, on sub-parallel predominant normal faults. Results show that the recent low magnitude earthquakes belongs to the background seismicity and they are likely generated along the major fault segments activated during the most recent earthquakes, suggesting that they are still active today thirty years after the mainshock occurrences. In this sense, this study gives a new perspective to the application of the high quality records of low magnitude background seismicity for the identification and characterization of active fault systems. The analysis of the stress tensor inversion provides two equivalent models to explain the microearthquake generation along both the NW-SE striking normal faults and the E- W oriented fault with a dominant dextral strike-slip motion, but having different geological interpretations. We suggest that the NW-SE-striking Africa-Eurasia convergence acts in the background of all these structures, playing a primary and unifying role in the seismotectonics of the whole region.

Integrating new and traditional approaches for the estimate of slip-rates of active faults: examples from the Mw 6.3, 2009 L’Aquila earthquake area, Central Italy

This thesis is based on the integration of traditional and innovative approaches aimed at improving the normal faults seimogenic identification and characterization, focusing mainly on slip-rate estimate as a measure of the fault activity. The L’Aquila Mw 6.3 April 6, 2009 earthquake causative fault, namely the Paganica - San Demetrio fault system (PSDFS), was used as a test site. We developed a multidisciplinary and scale‐based strategy consisting of paleoseismological investigations, detailed geomorphological and geological field studies, as well as shallow geophysical imaging and an innovative application of physical properties measurements. We produced a detailed geomorphological and geological map of the PSDFS, defining its tectonic style, arrangement, kinematics, extent, geometry and internal complexities. The PSDFS is a 19 km-long tectonic structure, characterized by a complex structural setting and arranged in two main sectors: the Paganica sector to the NW, characterized by a narrow deformation zone, and the San Demetrio sector to SE, where the strain is accommodated by several tectonic structures, exhuming and dissecting a wide Quaternary basin, suggesting the occurrence of strain migration through time. The integration of all the fault displacement data and age constraints (radiocarbon dating, optically stimulated luminescence (OSL) and tephrochronology) helped in calculating an average Quaternary slip-rate representative for the PSDFS of 0.27 - 0.48 mm/yr. On the basis of its length (ca. 20 km) and slip per event (up to 0.8 m) we also estimated a max expected Magnitude of 6.3-6.8 for this fault. All these topics have a significant implication in terms of surface faulting hazard in the area and may contribute also to the understanding of the PSDFS seismic behavior and of the local seismic hazard.

'Defending the rights'. An integrated model of collective action for "public water" in Italy

In many communities, supplying water for the people is a huge task and the fact that this essential service can be carried out by the private sector respecting the right to water, is a debated issue. This dissertation investigates the mechanisms through which a 'perceived rights violation' - which represents a specific form of perceived injustice which derives from the violation of absolute moral principles – can promote collective action. Indeed, literature on morality and collective action suggests that even if many people apparently sustain high moral principles (like human rights), only a minority decides to act in order to defend them. Taking advantage of the political situation in Italy, and the recent mobilization for "public water" we hypothesized that, because of its "sacred value", the perceived violation of the right to water facilitates identification with the social movement and activism. Through five studies adopting qualitative and quantitative methods, we confirmed our hypotheses demonstrating that the perceived violation of the right to water can sustain activism and it can influence vote intentions at the referendum for 'public water'. This path to collective action coexists with other 'classical' predictors of collective action, like instrumental factors (personal advantages, efficacy beliefs) and anger. The perceived rights violation can derive both from personal values (i.e. universalism) and external factors (i.e. a mobilization campaign). Furthermore, we demonstrated that it is possible to enhance the perceived violation of the right to water and anger through a specifically designed communication campaign. The final chapter summarizes the main findings and discusses the results, suggesting some innovative line of research for collective action literature.

Local home bias: Theory and new empirical evidence from Italy

This thesis examines the literature on local home bias, i.e. investor preference towards geographically nearby stocks, and investigates the role of firm’s visibility, profitability, and opacity in explaining such behavior. While firm’s visibility is expected to proxy for the behavioral root originating such a preference, firm’s profitability and opacity are expected to capture the informational one. I find that less visible, and more profitable and opaque firms, conditionally to the demand, benefit from being headquartered in regions characterized by a scarcity of listed firms (local supply of stocks). Specifically, research estimates suggest that firms headquartered in regions with a poor supply of stocks would be worth i) 11 percent more if non-visible, non-profitable and non-opaque; ii) 16 percent more if profitable; and iii) 28 percent more if both profitable and opaque. Overall, as these features are able to explain most, albeit not all, of the local home bias effect, I reasonably argue and then assess that most of the preference for local is determined by a successful attempt to exploit local information advantage (60 percent), while the rest is determined by a mere (irrational) feeling of familiarity with the local firm (40 percent). Several and significant methodological, theoretical, and practical implications come out.

Indoor and Outdoor Natural Radioactivity in the Vulsini Volcanic District (Central Italy): Estimation of Doses and Radiological Risks

Terrestrial radioactivity for most individual is the major contributor to the total dose and is mostly provided by 238U, 232Th and 40K radionuclides. In particular indoor radioactivity is principally due to 222Rn, a radioactive noble gas descendent of 238U, second cause of lung cancer after cigarettes smoking. Vulsini Volcanic District is a well known quaternary volcanic area located between the northern Latium and southern Tuscany (Central Italy). It is characterized by an high natural radiation background resulting from the high concentrations of 238U, 232Th and 40K in the volcanic products. In this context, subduction-related metasomatic enrichment of incompatible elements in the mantle source coupled with magma differentiation within the upper crust has given rise to U, Th and K enriched melts. Almost every ancient village and town located in this part of Italy has been built with volcanic rocks pertaining to the Vulsini Volcanic District. The radiological risk of living in this area has been estimated considering separately: a. the risk associated with buildings made of volcanic products and built on volcanic rock substrates b. the risk associated to soil characteristics. The former has been evaluated both using direct 222Rn indoor measurements and simulations of “standard rooms” built with the tuffs and lavas from the Vulsini Volcanic District investigated in this work. The latter has been carried out by using in situ measurements of 222Rn activity in the soil gases. A radon risk map for the Bolsena village has been developed using soil radon measurements integrating geological information. Data of airborne radioactivity in ambient aerosol at two elevated stations in Emilia Romagna (North Italy) under the influence of Fukushima plume have been collected, effective doses have been calculated and an extensive comparison between doses associated with artificial and natural sources in different area have been described and discussed.

Le reti in Sanità

Il presente lavoro di ricerca intende analizzare l’importanza dei modelli organizzativi a reti per rispondere alla sfida della complessità del momento storico, politico, sociologico, economico; in modo particolare in Sanità per rispondere all’esigenza di mettere al centro la persona nel percorso di cura ed ottenere una migliore integrazione delle cure. Sebbene i vantaggi delle reti siano bene descritti in letteratura sono ancora pochi gli studi nell’ambito della valutazione. Il caso di studio ha riguardato la rete oncologica romagnola così come percepita dagli informatori chiave, dagli operatori (medici, infermieri, amministrativi) e dalle persone con esperienza di tumore. Dall’analisi degli informatori chiave emerge forte che la rete nasce per dare risposte di qualità ai bisogni dei pazienti, mentre per gli operatori quanto sia importante la dimensione delle relazioni umane e avere valori condivisi per raggiungere obiettivi di efficacia e qualità delle cure. Per quanto riguarda invece la percezione delle persone con esperienza di tumore si rileva quanto sia importante l’appropriatezza della traiettoria di cura nonché l’avere continuità in un percorso, già di per sé difficile, oltre all’importanza dell’umanizzazione dei servizi e della corretta comunicazione medico paziente.

Immunoconiugati contenenti tossine vegetali o siRNA per la deplezione selettiva di cellule leucemiche. Preparazione, citotossicità e studi di mutagenesi sito-specifica.

CD33 is a myeloid cell surface marker absent on normal hematopoietic stem cells and normal tissues but present on leukemic blasts in 90% of adult and paediatric acute myeloid leukaemia (AML) cases. By virtue of its expression pattern and its ability to be rapidly internalized after antibody binding, CD33 has become an attractive target for new immunotherapeutic approaches to treat AML. In this study two immunoconjugates were constructed to contain a humanised single-chain fragment variable antibody (scFv) against CD33 in order to create new antibody-derived therapeutics for AML. The first immunoconjugate was developed to provide targeted delivery of siRNAs as death effectors into leukemic cells. To this purpose, a CD33-specific scFv, modified to include a Cys residue at its C-terminal end (scFvCD33-Cys), was coupled through a disulphide bridge to a nona-d-arginine (9R) peptide carrying a free Cys to the N-terminal. The scFvCD33-9R was able to completely bind siRNAs at a protein to nucleic acid ratio of about 10:1, as confirmed by electrophoretic gel mobility-shift assay. The conjugate was unable to efficiently transduce cytotoxic siRNA (siTox) into the human myeloid cell line U937. We observed slight reductions in cell viability, with a reduction of 25% in comparison to the control group only at high concentration of siTox (300 nM). The second immunoconjugate was constructed by coupling the scFvCD33-Cys to the type 1 ribosome inactivating protein Dianthin 30 (DIA30) through a chemical linking The resulting immunotoxin scFvCD33-DIA30 caused the rapid arrest of protein synthesis, inducing apoptosis and leading ultimately to cell death. In vitro dose-dependent cytotoxicity assays demonstrated that scFvCD33-DIA30 was specifically toxic to CD33-positive cell U937. The concentration needed to reach 50 % of maximum killing efficiency (EC50) was approximately 0.3 nM. The pronounced antigen-restricted cytotoxicity of this novel agent makes it a candidate for further evaluation of its therapeutic potential.

Analisi dei cantieri di Cippatura in merito ad aspetti operativi e di salvaguardia degli operatori

La cippatura è un processo produttivo fondamentale nella trasformazione della materia prima forestale in biomassa combustibile che coinvolgerà un numero sempre più crescente di operatori. Scopo dello studio è stato quantificare la produttività e il consumo di combustibile in 16 cantieri di cippatura e determinare i livelli di esposizione alla polvere di legno degli addetti alla cippatura, in funzione di condizioni operative differenti. Sono state identificate due tipologie di cantiere: uno industriale, con cippatrici di grossa taglia (300-400kW) dotate di cabina, e uno semi-industriale con cippatrici di piccola-media taglia (100-150kW) prive di cabina. In tutti i cantieri sono stati misurati i tempi di lavoro, i consumi di combustibile, l’esposizione alla polvere di legno e sono stati raccolti dei campioni di cippato per l’analisi qualitativa. Il cantiere industriale ha raggiunto una produttività media oraria di 25 Mg tal quali, ed è risultato 5 volte più produttivo di quello semi-industriale, che ha raggiunto una produttività media oraria di 5 Mg. Ipotizzando un utilizzo massimo annuo di 1500 ore, il cantiere semi-industriale raggiunge una produzione annua di 7.410 Mg, mentre quello industriale di 37.605 Mg. Il consumo specifico di gasolio (L per Mg di cippato) è risultato molto minore per il cantiere industriale, che consuma in media quasi la metà di quello semi-industriale. Riguardo all’esposizione degli operatori alla polvere di legno, tutti i campioni hanno riportato valori di esposizione inferiori a 5 mg/m3 (limite di legge previsto dal D.Lgs. 81/08). Nei cantieri semi-industriali il valore medio di esposizione è risultato di 1,35 mg/m3, con un valore massimo di 3,66 mg/m3. Nei cantieri industriali si è riscontrato che la cabina riduce drasticamente l’esposizione alle polveri di legno. I valori medi misurati all’esterno della cabina sono stati di 0,90 mg/m3 mentre quelli all’interno della cabina sono risultati pari a 0,20 mg/m3.

L'efficienza degli indici azionari: un'analisi empirica

La studio dell’efficienza di un indice azionario ha accresciuto la propria importanza nell’industria dell’asset management a seguito della diffusione dell’utilizzo di benchmark e investimenti indicizzati. Il presente lavoro valuta il livello di efficienza dei principali indici del mercato azionario statunitense, dell’Area Euro e italiano. Lo studio empirico ricorre a quattro misure di efficienza: il GRS, un test small-sample multivariato fondato sul CAPM; il test large sample di Wald, implementato tramite una simulazione bootstrap; il test GMM, che è stato applicato in una cornice non-gaussiana attraverso una simulazione block bootstrap; la misura di efficienza relativa di Kandel e Stambaugh. I risultati empirici forniscono una prova evidente della superiore efficienza degli indici equiponderati. Questa conclusione è interpretata sulla base della letteratura scientifica esistente, analizzando le diverse cause di ordine teorico ed empirico che sono state proposte.

Evoluzione Morfotettonica delle Aree Alpine "Sempione" e "Brennero" attraverso Studi Termocronologici di bassa temperatura

E’ mostrata l’analisi e la modellazione di dati termocronologici di bassa temperatura da due regioni Alpine: il Sempione ed il Brennero. Le faglie distensive presenti bordano settori crostali profondi appartenenti al dominio penninico: il duomo metamorfico Lepontino al Sempione e la finestra dei Tauri al Brennero. I dati utilizzati sono FT e (U-Th)/He su apatite. Per il Sempione i dati provengono dalla bibliografia; per il Brennero si è provveduto ad un nuovo campionamento, sia in superficie che in sotterraneo. Gli attuali lavori per la galleria di base del Brennero (BBT), hanno consentito, per la prima volta, di raccogliere dati di FT e (U-Th)/He in apatite in sottosuolo per la finestra dei Tauri occidentale. Le analisi sono state effettuate tramite un codice a elementi finiti, Pecube, risolvente l’equazione di diffusione del calore per una topografia evolvente nel tempo. Il codice è stato modificato per tener conto dei dati sotterranei. L’inversione dei dati è stata effettuata usando il Neighbourhood Algorithm (NA), per ottenere il più plausibile scenario di evoluzione morfotettonico. I risultati ottenuti per il Sempione mostrano: ipotetica evoluzione dello stile tettonico della faglia del Sempione da rolling hinge a low angle detachment a 6.5 Ma e la cessazione dell’attività a 3 Ma; costruzione del rilievo fino a 5.5 Ma, smantellamento da 5.5 Ma ad oggi, in coincidenza dei cambiamenti climatici Messiniani e relativi all’inizio delle maggiori glaciazioni; incremento dell’esumazione da 0–0.6 mm/anno a 0.6–1.2 mm/anno a 2.4 Ma nell’emisfero settentrionale. I risultati al Brennero mostrano: maggiore attività tettonica della faglia del Brennero (1.3 mm/anno), maggiore attività esumativa (1–2 mm/anno) prima dei 10 Ma; crollo dell’attività della faglia del Brennero fra 10 Ma e oggi (0.1 mm/anno) e dell’attività esumativa nello stesso periodo (0.1–0.3 mm/anno); nessun aumento del tasso esumativo o variazioni topografiche negli ultimi 5 Ma.

Synthesis and Supramolecular Architectures of Lipophilic Derivatives of Guanine

Self-assembly relies on the association of pre-programmed building blocks through non-covalent interactions to give complex supramolecular architectures. Previous studies provided evidence for the unique self-assembly properties of semi-synthetic lipophilic guanosine derivatives which can sequestrate ions from an aqueous phase, carry them into an organic phase where they promote the generation of well-defined supramolecular assemblies. In the presence of cations lipophilic guanosines form columnar aggregates while in their absence they generate supramolecular ribbons. The aim of this thesis has been the synthesis of guanine derivatives, in particular N9-alkylated guanines and a guanosine functionalized as a perchlorotriphenylmetil moiety (Gace-a-HPTM) in order to observe their supramolecular behaviour in the absence of sugar (ribose or deoxyribose) and in the presence of a bulky and chiral substituent respectively. By using guanine instead of guanosine, while maintaining all the hydrogen bond acceptor and donor groups required for supramolecular aggregation, the steric hindrance to supramolecular aggregation is notably reduced because (i.e. guanines with groups in N9 different from sugar are expected to have a greatest conformational freedom even in presence of bulky groups in C8). Supramolecular self-assembly of these derivatives has been accomplished in solutions by NMR and CD spectroscopy and on surface by STM technique. In analogy with other guanosine derivatives, also N9-substituted guanines and GAceHPTM form either ribbon-like aggregates or cation-templated G-quartet based columnar structures.

Study of Candidate Genes for production and carcass traits in Italian Heavy Pigs: identification of a new DNA Markers, Expression Studies and Association Analysis using Different Experimental Design

Heavy pig breeding in Italy is mainly oriented for the production of high quality processed products. Of particular importance is the dry cured ham production, which is strictly regulated and requires specific carcass characteristics correlated with green leg characteristics. Furthermore, as pigs are slaughtered at about 160 kg live weight, the Italian pig breeding sector faces severe problems of production efficiency that are related to all biological aspects linked to growth, feed conversion, fat deposition and so on. It is well known that production and carcass traits are in part genetically determined. Therefore, as a first step to understand genetic basis of traits that could have a direct or indirect impact on dry cured ham production, a candidate gene approach can be used to identify DNA markers associated with parameters of economic importance. In this thesis, we investigated three candidate genes for carcass and production traits (TRIB3, PCSK1, MUC4) in pig breeds used for dry cured ham production, using different experimental approaches in order to find molecular markers associated with these parameters.