Liver transplantation for transthyretin amyloidosis: experience of a single center in Italy

Liver transplantation is the only definitive treatment for transthyretin amyloidosis, with an excellent 5-year survival in endemic countries where the Met30 mutation is predominant. We report our experience of liver transplantation for transthyretin amyloidosis. We reviewed the clinical records of 17 transplanted patients (11 males, 6 females; age at liver transplant: 45.7±11.7 years). We had a wide spectrum of non-Met30 mutations (52.9%), with a predominance of Gln89 (23.5%). Five-year survival after transplantation was 43.8%; at multivariate analysis, both non-Met30 mutations (HR 17.3, 95% CI 1.03-291.7) and modified BMI (HR 0.50, 95% CI 0.29-0.87) showed significant and independent prognostic roles (P=0.048 and P=0.015, respectively). Five out of the 9 non-Met30 carriers received combined heart transplantation because of severe cardiomyopathy; they showed a trend towards a better prognosis vs. the 4 patients who did not receive combined heart transplantation (although not statistically significant; P=0.095). At follow-up, no significant improvement of transthyretin amyloidosis manifestations was observed. The results of liver transplantation for transthyretin amyloidosis in our population are poorer than those reported in the literature probably because of the high prevalence of non-Met30 mutations.

Essays in Applied Health Economics: Evidence on Health and Health Care in Italy and UK

This thesis is the result of my experience as a PhD student taking part in the Joint Doctoral Programme at the University of York and the University of Bologna. In my thesis I deal with topics that are of particular interest in Italy and in Great Britain. Chapter 2 focuses on the empirical test of the existence of the relationship between technological profiles and market structure claimed by Sutton’s theory (1991, 1998) in the specific economic framework of hospital care services provided by the Italian National Health Service (NHS). In order to test the empirical predictions by Sutton, we identify the relevant markets for hospital care services in Italy in terms of both product and geographic dimensions. In particular, the Elzinga and Hogarty (1978) approach has been applied to data on patients’ flows across Italian Provinces in order to derive the geographic dimension of each market. Our results provide evidence in favour of the empirical predictions of Sutton. Chapter 3 deals with the patient mobility in the Italian NHS. To analyse the determinants of patient mobility across Local Health Authorities, we estimate gravity equations in multiplicative form using a Poisson pseudo maximum likelihood method, as proposed by Santos-Silva and Tenreyro (2006). In particular, we focus on the scale effect played by the size of the pool of enrolees. In most of the cases our results are consistent with the predictions of the gravity model. Chapter 4 considers the effects of contractual and working conditions on selfassessed health and psychological well-being (derived from the General Health Questionnaire) using the British Household Panel Survey (BHPS). We consider two branches of the literature. One suggests that “atypical” contractual conditions have a significant impact on health while the other suggests that health is damaged by adverse working conditions. The main objective of our paper is to combine the two branches of the literature to assess the distinct effects of contractual and working conditions on health. The results suggest that both sets of conditions have some influence on health and psychological well-being of employees.

Velocity structure and seismic anisotropy in the crust and upper mantle from Receiver Function analysis: three case studies in Italy

The research for this PhD project consisted in the application of the RFs analysis technique to different data-sets of teleseismic events recorded at temporary and permanent stations located in three distinct study regions: Colli Albani area, Northern Apennines and Southern Apennines. We found some velocity models to interpret the structures in these regions, which possess very different geologic and tectonics characteristics and therefore offer interesting case study to face. In the Colli Albani some of the features evidenced in the RFs are shared by all the analyzed stations: the Moho is almost flat and is located at about 23 km depth, and the presence of a relatively shallow limestone layer is a stable feature; contrariwise there are features which vary from station to station, indicating local complexities. Three seismic stations, close to the central part of the former volcanic edifice, display relevant anisotropic signatures­­­ with symmetry axes consistent with the emplacement of the magmatic chamber. Two further anisotropic layers are present at greater depth, in the lower crust and the upper mantle, respectively, with symmetry axes directions related to the evolution of the volcano complex. In Northern Apennines we defined the isotropic structure of the area, finding the depth of the Tyrrhenian (almost 25 km and flat) and Adriatic (40 km and dipping underneath the Apennines crests) Mohos. We determined a zone in which the two Mohos overlap, and identified an anisotropic body in between, involved in the subduction and going down with the Adiratic Moho. We interpreted the downgoing anisotropic layer as generated by post-subduction delamination of the top-slab layer, probably made of metamorphosed crustal rocks caught in the subduction channel and buoyantly rising toward the surface. In the Southern Apennines, we found the Moho depth for 16 seismic stations, and highlighted the presence of an anisotropic layer underneath each station, at about 15-20 km below the whole study area. The moho displays a dome-like geometry, as it is shallow (29 km) in the central part of the study area, whereas it deepens peripherally (down to 45 km); the symmetry axes of anisotropic layer, interpreted as a layer separating the upper and the lower crust, show a moho-related pattern, indicated by the foliation of the layer which is parallel to the Moho trend. Moreover, due to the exceptional seismic event occurred on April 6th next to L’Aquila town, we determined the Vs model for two station located next to the epicenter. An extremely high velocity body is found underneath AQU station at 4-10 km depth, reaching Vs of about 4 km/s, while this body is lacking underneath FAGN station. We compared the presence of this body with other recent works and found an anti-correlation between the high Vs body, the max slip patches and earthquakes distribution. The nature of this body is speculative since such high velocities are consistent with deep crust or upper mantle, but can be interpreted as a as high strength barrier of which the high Vs is a typical connotation.

Very Long Baseline Interferometry in Italy Wide-field VLBI imaging and astrometry and prospects for an Italian VLBI network including the Sardinia Radio Telescope

In this thesis the use of widefield imaging techniques and VLBI observations with a limited number of antennas are explored. I present techniques to efficiently and accurately image extremely large UV datasets. Very large VLBI datasets must be reduced into multiple, smaller datasets if today’s imaging algorithms are to be used to image them. I present a procedure for accurately shifting the phase centre of a visibility dataset. This procedure has been thoroughly tested and found to be almost two orders of magnitude more accurate than existing techniques. Errors have been found at the level of one part in 1.1 million. These are unlikely to be measurable except in the very largest UV datasets. Results of a four-station VLBI observation of a field containing multiple sources are presented. A 13 gigapixel image was constructed to search for sources across the entire primary beam of the array by generating over 700 smaller UV datasets. The source 1320+299A was detected and its astrometric position with respect to the calibrator J1329+3154 is presented. Various techniques for phase calibration and imaging across this field are explored including using the detected source as an in-beam calibrator and peeling of distant confusing sources from VLBI visibility datasets. A range of issues pertaining to wide-field VLBI have been explored including; parameterising the wide-field performance of VLBI arrays; estimating the sensitivity across the primary beam both for homogeneous and heterogeneous arrays; applying techniques such as mosaicing and primary beam correction to VLBI observations; quantifying the effects of time-average and bandwidth smearing; and calibration and imaging of wide-field VLBI datasets. The performance of a computer cluster at the Istituto di Radioastronomia in Bologna has been characterised with regard to its ability to correlate using the DiFX software correlator. Using existing software it was possible to characterise the network speed particularly for MPI applications. The capabilities of the DiFX software correlator, running on this cluster, were measured for a range of observation parameters and were shown to be commensurate with the generic performance parameters measured. The feasibility of an Italian VLBI array has been explored, with discussion of the infrastructure required, the performance of such an array, possible collaborations, and science which could be achieved. Results from a 22 GHz calibrator survey are also presented. 21 out of 33 sources were detected on a single baseline between two Italian antennas (Medicina to Noto). The results and discussions presented in this thesis suggest that wide-field VLBI is a technique whose time has finally come. Prospects for exciting new science are discussed in the final chapter.

'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.

The role of collective action in the provision of agri-environmental public goods: theoretical development through case studies in Italy

The thesis aims at analysing the role of collective action as a viable alternative to the traditional forms of intervention in agriculture in order to encourage the provision of agri-environmental public goods. Which are the main benefits of collective action, in terms of effectiveness and efficiency, compared to traditional market or public intervention policies? What are the drivers that encourage farmers to participate into collective action? To what extent it is possible to incorporate collective aspects into policies aimed at providing agri-environmental public goods? With the objective of addressing these research questions, the thesis is articulated in two levels: a theoretical analysis on the role of collective action in the provision of public goods and a specific investigation of two local initiative,s were an approach collective management of agro-environmental resources was successfully implemented. The first case study concerns a project named “Custodians of the Territory”, developed by the local agency in Tuscany “Comunità Montana Media Valle del Serchio”, which settled for an agreement with local farmers for a collective provision of environmental services related to the hydro-geological management of the district. The second case study is related to the territorial agri-environmental agreement experimented in Valdaso (Marche), where local farmers have adopted integrated pest management practices collectively with the aim of reducing the environmental impact of their farming practices. The analysis of these initiatives, carried out through participatory methods (Rapid Rural Appraisal), allowed developing a theoretical discussion on the role of innovative tools (such as co-production and co-management) in the provision of agri-environmental public goods. The case studies also provided some recommendations on the government intervention and policies needed to promote successful collective action for the provision of agri-environmental public goods.

Integration of MFA and LCA methodologies: the anthropogenic aluminium cycle in Italy

MFA and LCA methodologies were applied to analyse the anthropogenic aluminium cycle in Italy with focus on historical evolution of stocks and flows of the metal, embodied GHG emissions, and potentials from recycling to provide key features to Italy for prioritizing industrial policy toward low-carbon technologies and materials. Historical trend series were collected from 1947 to 2009 and balanced with data from production, manufacturing and waste management of aluminium-containing products, using a ‘top-down’ approach to quantify the contemporary in-use stock of the metal, and helping to identify ‘applications where aluminium is not yet being recycled to its full potential and to identify present and future recycling flows’. The MFA results were used as a basis for the LCA aimed at evaluating the carbon footprint evolution, from primary and electrical energy, the smelting process and the transportation, embodied in the Italian aluminium. A discussion about how the main factors, according to the Kaya Identity equation, they did influence the Italian GHG emissions pattern over time, and which are the levers to mitigate it, it has been also reported. The contemporary anthropogenic reservoirs of aluminium was estimated at about 320 kg per capita, mainly embedded within the transportation and building and construction sectors. Cumulative in-use stock represents approximately 11 years of supply at current usage rates (about 20 Mt versus 1.7 Mt/year), and it would imply a potential of about 160 Mt of CO2eq emissions savings. A discussion of criticality related to aluminium waste recovery from the transportation and the containers and packaging sectors was also included in the study, providing an example for how MFA and LCA may support decision-making at sectorial or regional level. The research constitutes the first attempt of an integrated approach between MFA and LCA applied to the aluminium cycle in Italy.

New associations between native parasitoids and exotic insects introduced in Italy and in Europe

The introduction of exotic species is one of the most important threats to biodiversity.This phenomenon may cause economic and environmental damage. To prevent these invasions there are institutions like EPPO. Nevertheless, the introduction of exotic pests is an increasing issue, difficult to control. Classic biological control, based on importation of natural enemies from the country of origin, has been successfully used for over 120 years, but it has also raised some criticism. My research work has focused on the study of the new associations occurring between indigenous parasitoids and three exotic pests introduced in Italy and Europe. The three target insects considered were: Cacyreus marshalli Butler (Lepidoptera: Lycaenidae), a pest of Geranium plants; Dryocosmus kuriphilus Yasumatsu (Hymenoptera: Cynipidae), a plague of Castanea sp. and Harmonia axyridis (Pallas) (Coleoptera: Coccinellidae). This ladybug has been introduced as a biological control agent, but since some years it considered as an invasive species. For C. marshalli I performed laboratory tests on acceptance and suitability of immature stages of this butterfly by Exorista larvarum (Diptera: Tachinidae) and Brachymeria tibialis (Hymenoptera: Chalcidicae). The experiments showed that these two parasitoids could be used to contain this pest. For D. kuriphilus I performed field samplings in an infested chestnut area, the samples were maintained in rearing chamber until gall wasp or parasitoids emergence. In the 3-year research many parasitoids of gall wasps were found; one of these, Torymus flavipes (Walker), was found in large number. For H. axyridis the research work included a first phase of field sampling, during which I searched indigenous parasitoids which had adapted to this new host; the only species found was Dinocampus coccinellae (Schrank) (Hymenoptera: Braconidae). Laboratory tests were performed on the wasp rearing, biology and capacity to contain H. axyridis.

Agrofood chain analysis: production, commercialisation and consumption of healthy food for population at risk of poverty in Italy

Italy registers a fast increase of low income population. Academics and policy makers consider income inequalities as a key determinant for low or inadequate healthy food consumption. Thus the objective is to understand how to overcome the agrofood chain barriers towards healthy food production, commercialisation and consumption for population at risk of poverty (ROP) in Italy. The study adopts a market oriented food chain approach, focusing the research ambit on ROP consumers, processing industries and retailers. The empirical investigation adopts a qualitative methodology with an explorative approach. The actors are investigated through 4 focus groups for consumers and carrying out 27 face to face semi-structured interviews for industries and retailers’ representatives. The results achieved provide the perceptions of each actor integrated into an overall chain approach. The analysis shows that all agrofood actors lack of an adequate level of knowledge towards healthy food definition. Food industries and retailers also show poor awareness about ROP consumers’ segment. In addition they perceive that the high costs for producing healthy food conflict with the low economic performances expected from ROP consumers’ segment. These aspects induce a scarce interest in investing on commercialisation strategies for healthy food for ROP consumers. Further ROP consumers show other notable barriers to adopt healthy diets caused, among others, by a personal strong negative attitude and lack of motivation. The personal barriers are also negatively influenced by several external socio-economic factors. The solutions to overcome the barriers shall rely on the improvement of the agrofood chain internal relations to identify successful strategies for increasing interest on low cost healthy food. In particular the focus should be on improved collaboration on innovation adoption and marketing strategies, considering ROP consumers’ preferences and needs. An external political intervention is instead necessary to fill the knowledge and regulations’ gaps on healthy food issues.

Labour, LGBT* rights, and Europe. Discourses in Italy and Serbia

At the time of writing, all three elements that are evoked in the title – emancipation and social inclusion of sexual minorities, labour and labour activism, and the idea and substance of “Europe” – are being invested by deep, long-term, and – to varied degrees – radical processes of social transformation. The meaning of words like “equality”, “rights”, “inclusion”, and even “democracy” is as precarious and uncertain as are the lives of those European citizens who are marginalised by intersecting conditions of gender, sexuality, ethnicity, and class – in a constellation of precarities that is both unifying and fragmented (fragmenting). Conflicts are played, in hidden or explicit ways, over material processes of redistribution as well as discursive practices that revolve around these words. Against this backdrop, and roughly ten years after the European Union provided an input for institutional commitment to the protection of LGBT* workers' rights with the Council Directive 2000/78/EC, the dissertation contrasts discourses on workplace equality for LGBT* persons produced by a plurality of actors, seeking to identify values, semantics, and agendas framing and informing organisations’ views and showing how each actor has incorporated LGBT* rights into its own discourse, each time in a way that is functional to the construction and/or confirmation of its organisational identity: transnational union networks, by presenting LGBT* rights as a natural, neutral commitment within the framework of universal human rights protection; left-wing organisations, by collocating activism for LGBT* rights within a wider project of social emancipation that is for all the marginalised, yet is not neutral, but attached to specific values and opposed to specific political adversaries (the right-wing, the nationalists); business networks, by acknowledging diversity as a path to better performance and profits, thus encouraging inclusion and non-discrimination of “deserving” LGBT* workers.

Landscape ecology and genetics of the wolf in Italy

This PhD Thesis includes five main parts on diverse topics. The first two parts deal with the trophic ecology of wolves in Italy consequently to a recent increase of wild ungulates abundance. Data on wolf diet across time highlighted how wild ungulates are important food resource for wolves in Italy. Increasing wolf population, increasing numbers of wild ungulates and decreasing livestock consume are mitigating wolf-man conflicts in Italy in the near future. In the third part, non-invasive genetic sampling techniques were used to obtain genotypes and genders of about 400 wolves. Thus, wolf packs were genetically reconstructed using diverse population genetic and parentage software. Combining the results on pack structure and genetic relatedness with sampling locations, home ranges of wolf packs and dispersal patterns were identified. These results, particularly important for the conservation management of wolves in Italy, illustrated detailed information that can be retrieved from genetic identification of individuals. In the fourth part, wolf locations were combined with environmental information obtained as GIS-layers. Modern species distribution models (niche models) were applied to infer potential wolf distribution and predation risk. From the resulting distribution maps, information pastures with the highest risk of depredation were derived. This is particularly relevant as it allows identifying those areas under danger of carnivore attack on livestock. Finally, in the fifth part, habitat suitability models were combined with landscape genetic analysis. On one side landscape genetic analyses on the Italian wolves provided new information on the dynamics and connectivity of the population and, on the other side, a profound analysis of the effects that habitat suitability methods had on the parameterization of landscape genetic analyses was carried out to contributed significantly to landscape genetic theory.

Characterization of West Nile virus strains isolated in Italy

West Nile virus (WNV) is a neurotropic flavivirus that is maintained in an enzootic cycle between mosquitoes and birds, but can also infect and cause disease in humans and other vertebrate species. Most of WNV infections in humans are asymptomatic, but approximately 20% of infected people develop clinical symptoms, although severe neurological diseases are observed in less than 1% of them. WNV is the most widely distributed arbovirus in the world and has been recently associated with outbreaks of meningo-encephalitis in Europe, including Italy, caused by different viral strains belonging to distinct lineages 1 and 2. The hypothesis is that genetic divergence among viral strains currently circulating in Italy might reflect on their pathogenic potential and that the rapid spread of WNV with increased pathogenicity within naïve population suggest that epidemic forms of the virus may encode mechanisms to evade host immunity. Infection with WNV triggers a delayed host response that includes a delay in the production of interferon-α (IFN-α). IFNs are a family of immuno-modulatory cytokines that are produced in response to virus infection and serve as integral signal initiators of host intracellular defenses. The increased number of human cases and the lack of data about virulence of European WNV isolates highlight the importance to achieve a better knowledge on this emerging viral infection. In the present study, we investigate the phenotypic and IFN-α-regulatory properties of different WNV lineage 1 and 2 strains that are circulating in Europe/Italy in two cell lines: Vero and 1321N1. We demonstrate that: Vero and 1321N1 cells are capable of supporting WNV replication where different WNV strains show similar growth kinetics; WNV lineage 2 strain replicated in Vero and 1321N1 cells as efficiently as WNV lineage 1 strains; and both lineages 1 and 2 were highly susceptible to the antiviral actions of IFN-α.

Assessing Household Food Waste in Italy: A Methodology for Detecting Drivers and Quantities

It has been estimated that one third of edible food destined for human consumption is lost or wasted along the food supply chain globally. Much of the waste comes from Global North, where consumers are considered as the bigger contributors. Different studies tried to analyze and estimate the Household Food Waste (HFW), especially in UK and Northern Europe. The result is that accurate studies at national level exist only in UK, Finland and Norway while no such studies are available in Italy, except for survey- based researches. Though, there is a widespread awareness that such methods might be not able to estimate Food Waste. Results emerging from literature clearly suggest that survey estimate inferior amounts of Food Waste as a result, if compared to waste sorting and weighting analysis or to diary studies. The hypothesis that household food waste is under-estimated when gathered through questionnaires has been enquired into. First, a literature review of behavioral economics and heuristics has been proposed; then, a literature review of the sector listing the existing methodologies to gather national data on Household Food Waste has been illustrated. Finally, a pilot experiment to test a mixed methodology is proposed. While literature suggests that four specific cognitive biases might be able to affect the reliability of answers in questionnaires, results of the present experiment clearly indicate that there is a relevant difference between how much the individual thinks to waste and he/she actually does. The result is a mixed methodology based on questionnaire, diary and waste sorting, able to overcome the cons of each single method.

Timeliness, efficiency and public procurement in hip surgery in Italy

Considering different perspectives, the scope of this thesis is to investigate how to improve healthcare resources allocation and the provision efficiency for hip surgeries, a resource-intensive operation, among the most frequently performed on the elderly, with a trend in volume that is increasing in years due to population aging. Firstly, the effect of Time-To-Surgery (TTS) on mortality for hip fracture patients is investigated. The analysis attempts to account for TTS endogeneity due to the inability to fully control for variables affecting patient delay – e.g. patient severity. Exploiting an instrumental variable model, where being admitted on Friday or Saturday predicts longer TTS, findings show exogenous TTS does not have a significant effect on mortality. Thus suggesting surgeons prioritize patients effectively, neutralizing the adverse impact of longer TTS. Then, the volume-outcome relation for total hip replacement surgery is analyzed, seeking to account for selective referral, which may be present in elective surgery context, and induce reverse causality issue in the volume-outcome relation. The analysis employs a conditional choice model where patient travel distance from all regions' hospitals is used as a hospital choice predictor. Findings show the exogenous hospital volume significantly decreases adverse outcomes probability, especially in the short run. Finally, the change in public procurement design enforced in the Romagna LHA (Italy) is exploited to assess its impact on hip prostheses cost, surgeons' implant choice, and patient health outcomes. Hip prostheses are the major cost-driver of hip replacement surgeries, hence it is crucial to design the public tender such that implant prices are minimized, but cost-containment policies have to be weighted with patient well-being. Evidence shows that a cost reduction occurred without a significant surgeons’ choices impact. Positive or no effect of surgeons specialization is found on patients outcomes after the new procurement introduction.

European Union (EU) general farm animal directive applicability in Africa and bovine welfare assessment in Italy

The was conducted with objectives focusing on the EU farm animal directive and applicability in Africa focusing in Ethiopia, the welfare assessment and the effect of different bovine respiratory disease (BRD) treatment protocols in beef cattle fattening unit and the calves navel healing and fitness for transport. Different methodology was applied: relevant literates, international organization, regional organization, countries legislations, standards were assessed and reviewed, for assessing beef welfare and biosecurity a modified version of the Italian protocol for assessing beef cattle was adopted which is part of the ClassyFarm monitoring scheme, 264 Limousine bulls with an average age of 11 months at the entrance to fattening unit were considered. Mycoplasma bovis was tested using RT-PCR at arrival and with culture at after 15 days of arrival to the fattening unit. For studying the navel healing and effect on transport the navels of 299 dairy calves (55 males, 244 females) aged 0–90 days were examined. As a conclusion, the European Union (EU) farm directive, could not be completely implement in African countries like Ethiopia, but it could serve as a good starting point, so as after successful identification of the farm animal welfare critical points may help as a starting point with modification to the local situation in the ground. In beef welfare assessment, integration of different assessment parameters could be of useful, when assessing beef welfare, and further continues detail physiological parameters of welfare assessment for integration with other assessment protocols should be studied, our finding indicate that also BRD was a major welfare and health concern in the studied population and evidence the difficulties of antimicrobial treatment of M. bovis associated BRD. In transporting calves with a completely healed navel should be considered best practice because it ensures that calves that are too young are not transported.