Population ageing, longevity and migration: an overlapping generations approach

The silent demographic revolution characterizing the main industrialized countries is an unavoidable factor which has major economic, social, cultural and psychological implications. This thesis studies the main consequences of population ageing and the connections with the phenomenon of migration, The theoretical analysis is developed using Overlapping Generations Models (OLG). The thesis is divided in the following four chapters: 1) “A Model for Determining Consumption and Social Assistance Demand in Uncertainty Conditions”, focuses on the relation between demographic impact and social insurance and proposes the institution of a non selfsufficiency fund for the elderly. 2) "Population Ageing, Longevity and Health", analyzes the effects of health investment on intertemporal individual behaviour and capital accumulation. 3) "Population Ageing and the Nursing Flow", studies the consequences of migration in the nursing sector. 4) "Quality of Multiculturalism and Minorities' Assimilation", focuses on the problem of assimilation and integration of minorities.

Rekonstruktion der eiszeitlichen Verbreitung und Artbildung vier alpiner Primeln durch Artenverbreitungsmodelle und Phylogeographie

Aim: Previous studies revealed that diversification events in the western clade of the alpine Primula sect. Auricula were concentrated in the Quaternary cold periods. This implies that allopatric speciation in isolated glacial refugia was the most common mode of speciation. In the first part of the present dissertation, this hypothesis is further investigated by locating refugial areas of two sister species, Primula marginata & P. latifolia during the last glacial maximum, 21,000 years ago. In the second part, the glacial and postglacial history of P. hirsuta and P. daonensis is investigated. Location: European Alps. Methods: Glacial refugia were located using species distribution models, which are projected to last glacial maximum climate. These refugia are validated with geographic distribution patterns of intra-specific genetic diversity, rarity and variation. Results 1) Speciation: Glacial refugia of the sister taxa Primula marginata and P. latifolia were largely separated, only a small overlapping zone at the southern margin of the former glacier in the Maritime Alps exists. This overlapping zone is too small to indicate sympatric speciation. The largely separated glacial distribution of both species rather confirms our hypothesis of allopatric speciation in isolated glacial refugia. Results 2) Glacial and postglacial history: Surprizingly, the modelled potential refugia of three out of four Primula species are situated within the former ice-shield, except for P. marginata. This indicates that peripheral and central nunataks played an important role for the glacial survival in P. latifolia, P. hirsuta and P. daonensis, while peripheral refugia outside the maximum extend of the glacier were crucial in P. marginata. In P. hirsuta and P. latifolia SDMs allowed to exclude several hypothetical refugial areas that overlap with today’s distribution as potential refugia for the species. In P. marginata, hypothetical refugial areas at the periphery of the former ice-shield that overlap with today’s distribution were confirmed by the models. The results from the SDMs are confirmed by population genetic patterns in three out of four species. P. daonensis represents an exception, where population genetic data contradict the SDMs. Main conclusions: Species distribution models provide species specific scenarios of glacial distribution and postglacial re-colonization, which can be validated using population genetic analyses. This combined approach is useful and helps to understand the complex processes that have lead to the genetic and floristic patterns of biodiversity that is found today in the Alps.

Coordination and Control of Autonomous Mobile Robots Swarms by using Particle Swarm Optimization Algorithm and Consensus Theory

This thesis presents some different techniques designed to drive a swarm of robots in an a-priori unknown environment in order to move the group from a starting area to a final one avoiding obstacles. The presented techniques are based on two different theories used alone or in combination: Swarm Intelligence (SI) and Graph Theory. Both theories are based on the study of interactions between different entities (also called agents or units) in Multi- Agent Systems (MAS). The first one belongs to the Artificial Intelligence context and the second one to the Distributed Systems context. These theories, each one from its own point of view, exploit the emergent behaviour that comes from the interactive work of the entities, in order to achieve a common goal. The features of flexibility and adaptability of the swarm have been exploited with the aim to overcome and to minimize difficulties and problems that can affect one or more units of the group, having minimal impact to the whole group and to the common main target. Another aim of this work is to show the importance of the information shared between the units of the group, such as the communication topology, because it helps to maintain the environmental information, detected by each single agent, updated among the swarm. Swarm Intelligence has been applied to the presented technique, through the Particle Swarm Optimization algorithm (PSO), taking advantage of its features as a navigation system. The Graph Theory has been applied by exploiting Consensus and the application of the agreement protocol with the aim to maintain the units in a desired and controlled formation. This approach has been followed in order to conserve the power of PSO and to control part of its random behaviour with a distributed control algorithm like Consensus.

The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy

An interdisciplinary European group of clinical experts in the field of movement disorders and experienced Botulinum toxin users has updated the consensus for the use of Botulinum toxin in the treatment of children with cerebral palsy (CP). A problem-orientated approach was used focussing on both published and practice-based evidence. In part I of the consensus the authors have tabulated the supporting evidence to produce a concise but comprehensive information base, pooling data and experience from 36 institutions in 9 European countries which involves more than 10,000 patients and over 45,000 treatment sessions during a period of more than 280 treatment years. In part II of the consensus the Gross Motor Function Measure (GMFM) and Gross Motor Function Classification System (GMFCS) based Motor Development Curves have been expanded to provide a graphical framework on how to treat the motor disorders in children with CP. This graph is named "CP(Graph) Treatment Modalities - Gross Motor Function" and is intended to facilitate communication between parents, therapists and medical doctors concerning (1) achievable motor function, (2) realistic goal-setting and (3) treatment perspectives for children with CP. The updated European consensus 2009 summarises the current understanding regarding an integrated, multidisciplinary treatment approach using Botulinum toxin for the treatment of children with CP.

Allogeneic hematopoietic SCT as treatment option for patients with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE): a consensus conference proposal for a standardized approach

Allogeneic hematopoietic SCT (HSCT) has been proposed as a treatment for patients with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE). HSCT has been performed in nine patients using different protocols with varying success. Based on this preliminary experience, participants of the first consensus conference propose a common approach to allogeneic HSCT in MNGIE. Standardization of the transplant protocol and the clinical and biochemical assessments will allow evaluation of the safety and efficacy of HSCT as well as optimization of therapy for patients with MNGIE.Bone Marrow Transplantation advance online publication, 3 May 2010; doi:10.1038/bmt.2010.100.

Consensus Report: 2nd European Workshop on Tobacco Use Prevention and Cessation for Oral Health Professionals

Tobacco use has been identified as a major risk factor for oral disorders such as cancer and periodontal disease. Tobacco use cessation (TUC) is associated with the potential for reversal of precancer, enhanced outcomes following periodontal treatment, and better periodontal status compared to patients who continue to smoke. Consequently, helping tobacco users to quit has become a part of both the responsibility of oral health professionals and the general practice of dentistry. TUC should consist of behavioural support, and if accompanied by pharmacotherapy, is more likely to be successful. It is widely accepted that appropriate compensation of TUC counselling would give oral health professionals greater incentives to provide these measures. Therefore, TUC-related compensation should be made accessible to all dental professionals and be in appropriate relation to other therapeutic interventions. International and national associations for oral health professionals are urged to act as advocates to promote population, community and individual initiatives in support of tobacco use prevention and cessation (TUPAC) counselling, including integration in undergraduate and graduate dental curricula. In order to facilitate the adoption of TUPAC strategies by oral health professionals, we propose a level of care model which includes 1) basic care: brief interventions for all patients in the dental practice to identify tobacco users, assess readiness to quit, and request permission to re-address at a subsequent visit, 2) intermediate care: interventions consisting of (brief) motivational interviewing sessions to build on readiness to quit, enlist resources to support change, and to include cessation medications, and 3) advanced care: intensive interventions to develop a detailed quit plan including the use of suitable pharmacotherapy. To ensure that the delivery of effective TUC becomes part of standard care, continuing education courses and updates should be implemented and offered to all oral health professionals on a regular basis.

Immunophenotyping of acute leukemia and lymphoproliferative disorders: a consensus proposal of the European LeukemiaNet Work Package 10

The European LeukemiaNet (ELN), workpackage 10 (WP10) was designed to deal with diagnosis matters using morphology and immunophenotyping. This group aimed at establishing a consensus on the required reagents for proper immunophenotyping of acute leukemia and lymphoproliferative disorders. Animated discussions within WP10, together with the application of the Delphi method of proposals circulation, quickly led to post-consensual immunophenotyping panels for disorders on the ELN website. In this report, we established a comprehensive description of these panels, both mandatory and complementary, for both types of clinical conditions. The reason for using each marker, sustained by relevant literature information, is provided in detail. With the constant development of immunophenotyping techniques in flow cytometry and related software, this work aims at providing useful guidelines to perform the most pertinent exploration at diagnosis and for follow-up, with the best cost benefit in diseases, the treatment of which has a strong impact on health systems.

2010 International consensus algorithm for the diagnosis, therapy and management of hereditary angioedema

ABSTRACT:

Communication skills training in oncology: a position paper based on a consensus meeting among European experts in 2009

Background: Communication in cancer care has become a major topic of interest. Since there is evidence that ineffective communication affects both patients and oncology clinicians (physicians and nurses), so-called communication skills trainings (CSTs) have been developed over the last decade. While these trainings have been demonstrated to be effective, there is an important heterogeneity with regard to implementation and with regard to evidence of different aspects of CST. Methods: In order to review and discuss the scientific literature on CST in oncology and to formulate recommendations, the Swiss Cancer League has organised a consensus meeting with European opinion leaders and experts in the field of CST, as well as oncology clinicians, representatives of oncology societies and patient organisations. On the basis of a systematic review and a meta-analysis, recommendations have been developed and agreed upon. Results: Recommendations address (i) the setting, objectives and participants of CST, (ii) its content and pedagogic tools, (iii) organisational aspects, (iv) outcome and (v) future directions and research. Conclusion: This consensus meeting, on the basis of European expert opinions and a systematic review and meta-analysis, defines key elements for the current provision and future development and evaluation of CST in oncology.