The Integrated European Project "GEHA - GEnetics of Healthy Aging": recruitment, health status assessment and survival of the Italian 90+ sibpairs

The present study is part of the EU Integrated Project “GEHA – Genetics of Healthy Aging” (Franceschi C et al., Ann N Y Acad Sci. 1100: 21-45, 2007), whose aim is to identify genes involved in healthy aging and longevity, which allow individuals to survive to advanced age in good cognitive and physical function and in the absence of major age-related diseases. Aims The major aims of this thesis were the following: 1. to outline the recruitment procedure of 90+ Italian siblings performed by the recruiting units of the University of Bologna (UNIBO) and Rome (ISS). The procedures related to the following items necessary to perform the study were described and commented: identification of the eligible area for recruitment, demographic aspects related to the need of getting census lists of 90+siblings, mail and phone contact with 90+ subjects and their families, bioethics aspects of the whole procedure, standardization of the recruitment methodology and set-up of a detailed flow chart to be followed by the European recruitment centres (obtainment of the informed consent form, anonimization of data by using a special code, how to perform the interview, how to collect the blood, how to enter data in the GEHA Phenotypic Data Base hosted at Odense). 2. to provide an overview of the phenotypic characteristics of 90+ Italian siblings recruited by the recruiting units of the University of Bologna (UNIBO) and Rome (ISS). The following items were addressed: socio-demographic characteristics, health status, cognitive assessment, physical conditions (handgrip strength test, chair-stand test, physical ability including ADL, vision and hearing ability, movement ability and doing light housework), life-style information (smoking and drinking habits) and subjective well-being (attitude towards life). Moreover, haematological parameters collected in the 90+ sibpairs as optional parameters by the Bologna and Rome recruiting units were used for a more comprehensive evaluation of the results obtained using the above mentioned phenotypic characteristics reported in the GEHA questionnaire. 3. to assess 90+ Italian siblings as far as their health/functional status is concerned on the basis of three classification methods proposed in previous studies on centenarians, which are based on: • actual functional capabilities (ADL, SMMSE, visual and hearing abilities) (Gondo et al., J Gerontol. 61A (3): 305-310, 2006); • actual functional capabilities and morbidity (ADL, ability to walk, SMMSE, presence of cancer, ictus, renal failure, anaemia, and liver diseases) (Franceschi et al., Aging Clin Exp Res, 12:77-84, 2000); • retrospectively collected data about past history of morbidity and age of disease onset (hypertension, heart disease, diabetes, stroke, cancer, osteopororis, neurological diseases, chronic obstructive pulmonary disease and ocular diseases) (Evert et al., J Gerontol A Biol Sci Med Sci. 58A (3): 232-237, 2003). Firstly these available models to define the health status of long-living subjects were applied to the sample and, since the classifications by Gondo and Franceschi are both based on the present functional status, they were compared in order to better recognize the healthy aging phenotype and to identify the best group of 90+ subjects out of the entire studied population. 4. to investigate the concordance of health and functional status among 90+ siblings in order to divide sibpairs in three categories: the best (both sibs are in good shape), the worst (both sibs are in bad shape) and an intermediate group (one sib is in good shape and the other is in bad shape). Moreover, the evaluation wanted to discover which variables are concordant among siblings; thus, concordant variables could be considered as familiar variables (determined by the environment or by genetics). 5. to perform a survival analysis by using mortality data at 1st January 2009 from the follow-up as the main outcome and selected functional and clinical parameters as explanatory variables. Methods A total of 765 90+ Italian subjects recruited by UNIBO (549 90+ siblings, belonging to 258 families) and ISS (216 90+ siblings, belonging to 106 families) recruiting units are included in the analysis. Each subject was interviewed according to a standardized questionnaire, comprising extensively utilized questions that have been validated in previous European studies on elderly subjects and covering demographic information, life style, living conditions, cognitive status (SMMSE), mood, health status and anthropometric measurements. Moreover, subjects were asked to perform some physical tests (Hand Grip Strength test and Chair Standing test) and a sample of about 24 mL of blood was collected and then processed according to a common protocol for the preparation and storage of DNA aliquots. Results From the analysis the main findings are the following: - a standardized protocol to assess cognitive status, physical performances and health status of European nonagenarian subjects was set up, in respect to ethical requirements, and it is available as a reference for other studies in this field; - GEHA families are enriched in long-living members and extreme survival, and represent an appropriate model for the identification of genes involved in healthy aging and longevity; - two simplified sets of criteria to classify 90+ sibling according to their health status were proposed, as operational tools for distinguishing healthy from non healthy subjects; - cognitive and functional parameters have a major role in categorizing 90+ siblings for the health status; - parameters such as education and good physical abilities (500 metres walking ability, going up and down the stairs ability, high scores at hand grip and chair stand tests) are associated with a good health status (defined as “cognitive unimpairment and absence of disability”); - male nonagenarians show a more homogeneous phenotype than females, and, though far fewer in number, tend to be healthier than females; - in males the good health status is not protective for survival, confirming the male-female health survival paradox; - survival after age 90 was dependent mainly on intact cognitive status and absence of functional disabilities; - haemoglobin and creatinine levels are both associated with longevity; - the most concordant items among 90+ siblings are related to the functional status, indicating that they contain a familiar component. It is still to be investigated at what level this familiar component is determined by genetics or by environment or by the interaction between genetics, environment and chance (and at what level). Conclusions In conclusion, we could state that this study, in accordance with the main objectives of the whole GEHA project, represents one of the first attempt to identify the biological and non biological determinants of successful/unsuccessful aging and longevity. Here, the analysis was performed on 90+ siblings recruited in Northern and Central Italy and it could be used as a reference for others studies in this field on Italian population. Moreover, it contributed to the definition of “successful” and “unsuccessful” aging and categorising a very large cohort of our most elderly subjects into “successful” and “unsuccessful” groups provided an unrivalled opportunity to detect some of the basic genetic/molecular mechanisms which underpin good health as opposed to chronic disability. Discoveries in the topic of the biological determinants of healthy aging represent a real possibility to identify new markers to be utilized for the identification of subgroups of old European citizens having a higher risk to develop age-related diseases and disabilities and to direct major preventive medicine strategies for the new epidemic of chronic disease in the 21st century.

Formal planning rationality in public sector professional work: between discourse and practice

Although rational models of formal planning have been seriously criticized by strategy literature, they not only remain a widely used organizational practice in private firms, but they have increasingly been entering public, professional organizations too, as part of public sector managerial reforms. This research addresses this apparent paradox, exploring the meaning of formal planning in public sector professional work. Curiously, this is an issue that remains under-investigated in the literature: the long debate on formal planning in strategy research devoted scant attention to its diffusion in the public sector, and public sector studies have scrutinized the introduction of other management tools in professional work, but very limitedly formal planning itself. In fact, little is known on the actual meaning of formal planning in public, professional services. This research is based upon a case of adoption of formal planning tools in a public hospital. Embracing a discourse analytical lens, it examines which formal planning discourse entered professional work, to what extent, and how professionals interpret it and engage with it in their practice. The analysis uncovers dynamics of social construction of meaning where, eventually, a formal planning discourse both shapes and is shaped by professional practice. In particular, it is found that formal planning rationality largely penetrated professional work, but not to the detriment of professional values. Morevover, formal planning ‘fails’ as a tool for rational decision making, but it takes up a knowledge work and a social value in professional work, as a tool for explicitation of action courses and for dialogue between otherwise more disconnected parts of the organization.

Determinants of child undernutrition in India. A micro-case study to operationalize the Capability Approach

The present research aims at shedding light on the demanding puzzle characterizing the issue of child undernutrition in India. Indeed, the so called ‘Indian development paradox’ identifies the phenomenon according to which higher level of income per capita is recorded alongside a lethargic reduction in the proportion of underweight children aged below three years. Thus, in the time period occurring from 2000 to 2005, real Gross Domestic Production per capita has annually grown at 5.4%, whereas the proportion of children who are underweight has declined from 47% to 46%, a mere one point percent. Such trend opens up the space for discussing the traditionally assumed linkage between income-poverty and undernutrition as well as food intervention as the main focus of policies designed to fight child hunger. Also, it unlocks doors for evaluating the role of an alternative economic approach aiming at explaining undernutrition, such as the Capability Approach. The Capability Approach argues for widening the informational basis to account not only for resources, but also for variables related to liberties, opportunities and autonomy in pursuing what individuals value.The econometric analysis highlights the relevance of including behavioral factors when explaining child undernutrition. In particular, the ability of the mother to move freely in the community without the need of asking permission to her husband or mother-in-law is statistically significant when included in the model, which accounts also for confounding traditional variables, such as economic wealth and food security. Also, focusing on agency, results indicates the necessity of measuring autonomy in different domains and the need of improving the measurement scale for agency data, especially with regards the domain of household duties. Finally, future research is required to investigate policy venues for increasing agency in women and in the communities they live in as viable strategy for reducing the plague of child undernutrition in India.

Three Essays in Spatial Economics

This work contributes to the field of spatial economics by embracing three distinct modelling approaches, belonging to different strands of the theoretical literature. In the first chapter I present a theoretical model in which the changes in urban system’s degree of functional specialisation are linked to (i) firms’ organisational choices and firms’ location decisions. The interplay between firms’ internal communication/managing costs (between headquarters and production plants) and the cost of communicating with distant business services providers leads the transition process from an “integrated” urban system where each city hosts every different functions to a “functionally specialised” urban system where each city is either a primary business center (hosting advanced business services providers, a secondary business center or a pure manufacturing city and all this city-types coexist in equilibrium.The second chapter investigates the impact of free trade on welfare in a two-country world modelled as an international Hotelling duopoly with quadratic transport costs and asymmetric countries, where a negative environmental externality is associated with the consumption of the good produced in the smaller country. Countries’ relative sizes as well as the intensity of negative environmental externality affect potential welfare gains of trade liberalisation. The third chapter focuses on the paradox, by which, contrary to theoretical predictions, empirical evidence shows that a decrease in international transport costs causes an increase in foreign direct investments (FDIs). Here we propose an explanation to this apparent puzzle by exploiting an approach which delivers a continuum of Bertrand- Nash equilibria ranging above marginal cost pricing. In our setting, two Bertrand firms, supplying a homogeneous good with a convex cost function, enter the market of a foreign country. We show that allowing for a softer price competition may indeed more than offset the standard effect generated by a decrease in trade costs, thereby restoring FDI incentives.

Design and Development of a Research Framework for Prototyping Control Tower Augmented Reality Tools

The purpose of the air traffic management system is to ensure the safe and efficient flow of air traffic. Therefore, while augmenting efficiency, throughput and capacity in airport operations, attention has rightly been placed on doing it in a safe manner. In the control tower, many advances in operational safety have come in the form of visualization tools for tower controllers. However, there is a paradox in developing such systems to increase controllers' situational awareness: by creating additional computer displays, the controller's vision is pulled away from the outside view and the time spent looking down at the monitors is increased. This reduces their situational awareness by forcing them to mentally and physically switch between the head-down equipment and the outside view. This research is based on the idea that augmented reality may be able to address this issue. The augmented reality concept has become increasingly popular over the past decade and is being proficiently used in many fields, such as entertainment, cultural heritage, aviation, military & defense. This know-how could be transferred to air traffic control with a relatively low effort and substantial benefits for controllers’ situation awareness. Research on this topic is consistent with SESAR objectives of increasing air traffic controllers’ situation awareness and enable up to 10 % of additional flights at congested airports while still increasing safety and efficiency. During the Ph.D., a research framework for prototyping augmented reality tools was set up. This framework consists of methodological tools for designing the augmented reality overlays, as well as of hardware and software equipment to test them. Several overlays have been designed and implemented in a simulated tower environment, which is a virtual reconstruction of Bologna airport control tower. The positive impact of such tools was preliminary assessed by means of the proposed methodology.

La paradoja de Maastricht. Los distintos modelos económicos y políticos para el futuro integrador de la UE

La crisis existencial del proyecto de integración europea constituye el principal reto al que debe enfrentarse la Comunidad en su futuro más inmediato puesto que se alza como toda una amenaza para la continuidad del sistema establecido desde el Tratado fundacional de Roma (1957). Las tres crisis acontecidas durante los primeros años del siglo XXI, véase la gran crisis económica del año 2008, la pandemia global de la Covid-19 y la actual intervención de la Federación Rusa en Ucrania, están poniendo constantemente a prueba la firmeza de los cimientos y valores sobre los cuales se ha construido la Comunidad durante todos estos años. Esta tesis doctoral pretende ser una contribución académica al debate abierto en las sociedades comunitarias acerca de por donde debe de transitar la evolución del proyecto de integración europea en los próximos años. Para conseguir alcanzar este objetivo, la investigación se retrotrae hasta los orígenes del proceso de integración y avanza en la línea temporal hasta nuestros días, analizando con ello las posibles causas que pudieran encontrarse detrás de la crisis existencial actual. A su vez, , la investigación estudia con detenimiento los múltiples efectos que está generando la problemática existencial en los Estados miembros en los últimos años, tales como el aumento del apoyo social a favor de actores considerados populistas o el fenómeno de la creciente desafección ciudadana. Esta investigación analiza los distintos escenarios propuestos por la Comisión Europea en su Libro Blanco sobre el futuro de Europa para determinar cuál podría ser el mejor escenario que concordara con la nueva realidad económica y sociopolítica que actualmente impera en los Estados miembro. Lo que se persigue es formular una propuesta que pueda dar por terminada la crisis existencial de la Comunidad abriendo con ello una nueva etapa en la historia de la integración europea.

On making web accessibility more accessible: strategy and tools for social good

The world currently faces a paradox in terms of accessibility for people with disabilities. While digital technologies hold immense potential to improve their quality of life, the majority of web content still exhibits critical accessibility issues. This PhD thesis addresses this challenge by proposing two interconnected research branches. The first introduces a groundbreaking approach to improving web accessibility by rethinking how it is approached, making it more accessible itself. It involves the development of: 1. AX, a declarative framework of web components that enforces the generation of accessible markup by means of static analysis. 2. An innovative accessibility testing and evaluation methodology, which communicates test results by exploiting concepts that developers are already familiar with (visual rendering and mouse operability) to convey the accessibility of a page. This methodology is implemented through the SAHARIAN browser extension. 3. A11A, a categorized and structured collection of curated accessibility resources aimed at facilitating their intended audiences discover and use them. The second branch focuses on unleashing the full potential of digital technologies to improve accessibility in the physical world. The thesis proposes the SCAMP methodology to make scientific artifacts accessible to blind, visually impaired individuals, and the general public. It enhances the natural characteristics of objects, making them more accessible through interactive, multimodal, and multisensory experiences. Additionally, the prototype of \gls{a11yvt}, a system supporting accessible virtual tours, is presented. It provides blind and visually impaired individuals with features necessary to explore unfamiliar indoor environments, while maintaining universal design principles that makes it suitable for usage by the general public. The thesis extensively discusses the theoretical foundations, design, development, and unique characteristics of these innovative tools. Usability tests with the intended target audiences demonstrate the effectiveness of the proposed artifacts, suggesting their potential to significantly improve the current state of accessibility.