14 research outputs found
Is the Digital Divide an Obstacle to e-Health? An Analysis of the Situation in Europe and in Italy
No full textIntroduction: The digital divide affecting elderly patients may
compromise the diffusion of telemedicine systems for this age
segment. It might be that the difficulties in the passage from trials
to the effective distribution of telemedicine systems are also due to the awareness of a personal digital divide in the target population.
Materials and Methods: The analysis aims to estimate the number of people over the age of 50 years with potential cardiovascular
problems able to access the Web. It made use of data from several sources (the Survey of Health, Ageing and Retirement in Europe and the Instituto Nazionale di Statisci Multiscopo Survey). Furthermore, with regard to Italy, the estimates obtained from official data were compared with those obtained in a survey investigating heart failure patients in Tuscany.
Results: In 2011, the percentage of people suffering from cardiovascular diseases and with Web access was 24% in Europe, with significant differences by country (ranging from 53% in Switzerland to below 20% in Italy, Spain, and Portugal). In Italy, however, the proportion of people with Web access increased from 2007 to 2011, and the survey in Tuscany showed that elderly people with limited information and communications technology skills overcame challenges and learned how to connect to the Web because they started to appreciate new technologies.
Conclusions: The opportunity to use the Internet to monitor patients with chronic disease can serve as a challenge to reduce the digital divide gap and, furthermore, to increase their social and technological inclusion
Macroeconomic theory and stabilization policy
No full textA textbook for graduate and advanced undergraduate students outlining the main debates and issues in modern macroeconomics as they relate to questions of macroeconomic policy. Presumes a knowledge and grasp of intermediate macroeconomics. Concentrates on key issues rather than comprehensively covering macroeconomic theory and policy. Reviews the theory of aggregate demand and the classical versus Keynesian debate on underemployment equilibrium. Discusses aggregate supply in monetarist and new classical macroeconomics; the Keynesian perspective on aggregate supply and stabilization policies; money, financial markets, and aggregate demand; fiscal policy and aggregate demand; macroeconomic policy and the balance of payments; macroeconomic policy and the exchange rate; macroeconomic policy design; and international interdependence and policy coordination. Stevenson and Muscatelli are at the University of Glasgow. Gregory is at the University of Oxford. Bibliography; author and subject indexes
TECNICHE MODERNE DI INTERVENTO SUBACQUEO: L’UOMO E I SISTEMI
No full textLa tesi analizza l'evoluzione storica e tecnologica delle tecniche subacquee, concentrandosi sull'integrazione tra operatori umani e sistemi avanzati. L'obiettivo principale è dimostrare come l'innovazione tecnologica abbia trasformato il settore delle immersioni, migliorando sicurezza, efficienza e capacità operative, pur mantenendo un ruolo cruciale per l'addestramento e la competenza degli operatori.
Nel primo capitolo viene esplorata la storia delle principali tecnologie subacquee, partendo dagli autorespiratori fino alla campana subacquea. Si analizzano l’evoluzione delle attrezzature da palombaro e i primi utilizzi di sottomarini e cassoni subacquei, strumenti che hanno rivoluzionato l’accesso a profondità maggiori. Inoltre, si dedica attenzione al contributo fondamentale dei pionieri italiani nelle immersioni industriali, figure che, attraverso innovazioni e sperimentazioni, hanno contribuito allo sviluppo delle tecnologie moderne. Questo contesto storico fornisce una solida base per comprendere come le tecnologie subacquee abbiano progressivamente evoluto il rapporto tra l’uomo e l’ambiente subacqueo.
Il secondo capitolo approfondisce le apparecchiature utilizzate nelle immersioni professionali. Tra queste, il processo di progettazione dello scafandro da palombaro viene analizzato in dettaglio, insieme ai principi di funzionamento dello scafandro normale (A.N.). Particolare enfasi è posta sullo scafandro rigido articolato, progettato per operazioni a grandi profondità, dove la sicurezza e l’ergonomia diventano essenziali. Gli accessori fondamentali per garantire immersioni sicure, le procedure di manutenzione e conservazione, così come il vestiario per apparecchiature leggere, dimostrano come ogni dettaglio tecnologico sia calibrato per ottimizzare la protezione dell’operatore e massimizzare la funzionalità.
Il terzo capitolo affronta la tecnologia degli impianti di immersione in saturazione, una metodologia che permette di operare a grandi profondità per periodi prolungati. L’analisi si focalizza sui sistemi di controllo e automazione, essenziali per garantire sicurezza ed efficienza nelle operazioni subacquee. Viene approfondito il ruolo delle camere di decompressione, strumenti indispensabili per prevenire patologie legate alla decompressione, e si esplorano i sistemi di lancio e recupero delle campane, tecnologie che rappresentano il cuore delle missioni più avanzate. L’adozione di queste tecnologie sottolinea l’importanza di soluzioni integrate e altamente affidabili per gestire le complessità delle immersioni profonde.
Nel quarto capitolo si discute delle operazioni di salvataggio subacqueo, con un focus particolare sulle esercitazioni internazionali SMEREX. Durante il tirocinio estivo del 2024, l'autore ha partecipato a esercitazioni a Taranto, acquisendo esperienza diretta in queste operazioni. Il ruolo dell’organizzazione internazionale ISMERLO, che coordina le missioni di salvataggio di sottomarini sinistrati, è al centro dell’analisi. Tecnologie come la campana di salvataggio McCann e i sistemi SRV-300 e SRV-650 vengono descritti nelle loro caratteristiche tecniche e operative, evidenziando come l’interazione tra macchine sofisticate e operatori umani altamente qualificati sia fondamentale per il successo delle missioni. L’esperienza pratica ha permesso una comprensione più profonda delle sfide e dei progressi nel settore del salvataggio subacqueo, sottolineando l’importanza della cooperazione multinazionale per la sicurezza delle operazioni.
Il quinto capitolo è dedicato alle attrezzature subacquee moderne, con particolare attenzione ai caschi Kirby Morgan, strumenti ampiamente utilizzati nelle immersioni professionali. La progettazione avanzata del casco Super Lite 17 A/B è esaminata nei dettagli, con attenzione alle sue specifiche operative, ai sistemi di fornitura di gas di emergenza e ai meccanismi per ridurre l'accumulo di anidride carbonica. Si analizzano anche le tecnologie per comunicazioni subacquee e i sistemi di equalizzazione delle cavità sinusali e dell’orecchio interno. Una sezione importante è dedicata al casco D-ONE, che combina ergonomia e innovazione tecnologica, offrendo soluzioni avanzate per le immersioni più complesse.
La tesi conclude evidenziando come l’evoluzione delle tecnologie subacquee sia strettamente connessa alla capacità di bilanciare l’interazione tra l’uomo e i sistemi tecnologici. Le innovazioni hanno permesso di estendere la durata e la profondità delle immersioni, aumentando al contempo gli standard di sicurezza e le prestazioni operative. Tuttavia, nonostante i progressi significativi, il ruolo dell’operatore umano rimane centrale. Un addestramento adeguato, insieme allo sviluppo continuo di protocolli di sicurezza, è essenziale per garantire l’efficacia e la sicurezza delle operazioni subacquee. La combinazione tra competenza umana e tecnologie all’avanguardia rappresenta il pilastro fondamentale per affrontare le sfide del futuro nel settore delle immersioni.
TRADUZIONE IN INGLESE
The thesis analyzes the historical and technological evolution of underwater techniques, focusing on the integration between human operators and advanced systems. The main objective is to demonstrate how technological innovation has transformed the diving sector, improving safety, efficiency and operational capabilities, while maintaining a crucial role in operator training and competence.
The first chapter explores the history of the main underwater technologies, starting from self-contained breathing apparatus to the diving bell. The evolution of diving equipment and the first uses of submarines and underwater caissons, tools that have revolutionized access to greater depths, are analyzed. Furthermore, attention is paid to the fundamental contribution of Italian pioneers in industrial diving, figures who, through innovations and experiments, have contributed to the development of modern technologies. This historical context provides a solid basis for understanding how underwater technologies have progressively evolved the relationship between man and the underwater environment.
The second chapter delves into the equipment used in professional diving. Among these, the design process of the diving suit is analyzed in detail, together with the operating principles of the normal suit (A.N.). Particular emphasis is placed on the articulated rigid suit, designed for operations at great depths, where safety and ergonomics become essential. The essential accessories to ensure safe diving, the maintenance and conservation procedures, as well as the clothing for light equipment, demonstrate how every technological detail is calibrated to optimize the operator's protection and maximize functionality. The third chapter addresses the technology of saturation diving systems, a methodology that allows operating at great depths for prolonged periods. The analysis focuses on the control and automation systems, essential to ensure safety and efficiency in underwater operations. The role of decompression chambers, indispensable tools for preventing decompression-related pathologies, is explored, and the bell launch and recovery systems, technologies that represent the heart of the most advanced missions. The adoption of these technologies highlights the importance of integrated and highly reliable solutions to manage the complexities of deep-sea diving.
The fourth chapter discusses underwater rescue operations, with a special focus on the international SMEREX exercises. During the 2024 summer internship, the author participated in exercises in Taranto, gaining direct experience in these operations. The role of the international organization ISMERLO, which coordinates rescue missions of stricken submarines, is at the center of the analysis. Technologies such as the McCann rescue bell and the SRV-300 and SRV-650 systems are described in their technical and operational characteristics, highlighting how the interaction between sophisticated machines and highly skilled human operators is crucial for the success of the missions. Practical experience has allowed a deeper understanding of the challenges and advances in the underwater rescue sector, underlining the importance of multinational cooperation for the safety of operations.
The fifth chapter is dedicated to modern diving equipment, with a special focus on Kirby Morgan helmets, tools widely used in professional diving. The advanced design of the Super Lite 17 A/B helmet is examined in detail, with attention to its operational specifications, emergency gas supply systems and mechanisms to reduce carbon dioxide accumulation. The underwater communication technologies and the sinus and inner ear equalization systems are also analyzed. An important section is dedicated to the D-ONE helmet, which combines ergonomics and technological innovation, offering advanced solutions for the most complex dives.
The thesis concludes by highlighting how the evolution of underwater technologies is closely linked to the ability to balance the interaction between humans and technological systems. Innovations have allowed to extend the duration and depth of dives, while increasing safety standards and operational performance. However, despite significant progress, the role of the human operator remains central. Appropriate training, together with the continuous development of safety protocols, is essential to ensure the effectiveness and safety of diving operations. The combination of human expertise and cutting-edge technologies represents the fundamental pillar to face the challenges of the future in the sector
Micro‐RNA‐21 (biomarker) and global longitudinal strain (functional marker) in detection of myocardial fibrotic burden in severe aortic valve stenosis: a pilot study
No full textAims: Myocardial fibrosis (MF) is a deleterious consequence of aortic valve stenosis (AVS). Global longitudinal strain (GLS) is a novel left ventricular (LV) functional parameter potentially useful to non-invasively estimate MF. MicroRNAs (miRNAs) are non-coding small ribonucleic acids (RNA) modulating genes function, mainly through RNA degradation. miRNA-21 is a biomarker associated with MF in pressure overload. The aim of the present study was to find an integrated algorithm for detection of MF using a combined approach with both bio- and functional markers. Methods: Thirty-six patients (75.2±8 y.o.; 63% Female) with severe AVS and preserved LV ejection fraction (EF), candidate to surgical aortic valve replacement (sAVR) were enrolled. Clinical, bio-humoral evaluation (including plasmatic miRNA-21 collected using specific tubes, PAXgene, for stabilization of peripheral RNA) and a complete echocardiographic study, including GLS and septal strain, were performed before sAVR. Twenty-eight of those patients underwent sAVR and, in 23 of them, an inter-ventricular septum biopsy was performed. Tissues were fixed in formalin and embedded in paraffin. Sections were stained with Hematoxylin and Eosin for histological evaluation and with histochemical Masson trichrome for collagen fibers. The different components were calculated and expressed as micrometers2. To evaluate tissue miRNA components, sections2-μm thick were cut using a microtome blade for each slide. Regression analysis was performed to test association between dependent variable and various predictors included in the model. Results: Despite a preserved EF (66±11%), patients presented altered myocardial deformation parameters (GLS -14,02±3.8%; septal longitudinal strain, SSL -9.63±2.9%; septal longitudinal strain rate, SL-Sr -0.58±0.17 1/s; Septal Longitudinal early-diastolic strain rate, SL-SrE 0.62±0.32 1/s). The extent of MF showed an inverse association with both GLS and septal longitudinal deformation indices (GLS: R2=0.30; p=0.02; SSL: R2=0.36; p=0.01; SL-Sr: R2=0.39; p<0.001; SL-SrE: R2=0.35; p=0.001). miRNA-21 was mainly expressed in fibrous tissue (p<0.0001). A significant association between MF and plasmatic miRNA-21, alone and weighted for measures of structural (LVMi R2=0.50; p=0.0005) and functional (SSL R2=0.35; p=0.006) remodeling, was found. Conclusions: In AVS, MF is associated with alterations of regional and global strain. Plasmatic miRNA-21 is directly related to MF and associated with LV structural and functional impairment. © 2016 The Author(s)
Combining Home Monitoring temporal trends from implanted defibrillators and baseline patient risk profile to predict heart failure hospitalizations: results from the SELENE HF study
No full textWe developed and validated an algorithm for prediction of heart failure (HF) hospitalizations using remote monitoring (RM) data transmitted by implanted defibrillators
PROGRESS IN CANCER INCIDENCE, MORTALITY, AND SURVIVAL
No full textCancer mortality has declined over the last three decades in most high-income countries reflecting improvements in cancer prevention, diagnosis, treatments, and management. However, there are persisting and substantial differences in mortality, incidence, and survival worldwide.
Using the World Health Organization (WHO) database I worked on the trends and projections analysis of mortality from various cancer sites. I computed age-specific rates for each 5-year age group, calendar year, and sex globally. I then computed age-standardized mortality rates per 100,000 person-years using the direct method based on the world standard population. I performed joinpoint models to identify the years when significant changes in trends occurred and I calculated the corresponding annual percent changes. For the mortality projections, I predicted the number deaths and rates for a specific calendar year, using a logarithmic Poisson count data joinpoint regression model.
My first study on this topic aimed to provide an up-to-date overview of trends in cancer mortality, incidence, and survival among adults, retrieving data from high-quality population-based cancer registries in seven high-income countries and the European Union. Mortality from all cancers and most common cancer sites has declined over the last three decades, except for pancreas and lung (in women). The patterns for incidence were less consistent between countries, except for a steady decrease in stomach cancer in both sexes and lung cancer in men. Survival for all cancers and the selected cancer sites increased in all countries, although there is still substantial variability. Although overall cancer death rates continue to decline, incidence rates have been levelling off among males and have been moderately increasing among females. These trends reflect population changes in cancer risk factors, screening test use, diagnostic practices, and treatment advances. Many cancers can be prevented or treated effectively if they are diagnosed early. Population-based cancer incidence and mortality data can be used to inform efforts to decrease the cancer burden and regularly monitor progress toward goals.
I had the opportunity to collaborate with the University of Miami Miller School of Medicine, which provided data on cancer mortality among Italy-born Americans in California, Florida, Massachusetts, and New York Departments of Vital Statistics. The comparison of cancer mortality rates and risk factors among foreign-born populations in a host country with those in the country of origin provides insights into differences in access to care, timely diagnosis, and disease management between the two countries. Moreover, cancer studies on specific European-born populations in the USA are scarce. Using official Italian death certificate data and resident population estimates based on the official census from the WHO, I was able to conduct a study to compare cancer mortality rates between Italians and Italy-born Americans. Generational differences in smoking prevalence patterns between the USA and Italy may explain the advantages for Italy-born Americans for lung and other tobacco-related cancers compared to their Italian male counterparts. The lower prevalence of Helicobacter pylori, alcohol consumption, and hepatitis B and C virus in the USA may justify the lower mortality for stomach and liver cancer, among Italy-born Americans. Earlier and more widespread adoption of cancer screening and effective treatments in the USA is likely to be influential in breast, colorectal, and prostate cancer mortality.
I then focused my studies on urologic cancer mortality over time and predictions. I carried out a time-trend analysis for selected European countries for prostate, testis, bladder, and kidney cancers over the last four decades. Prostate cancer mortality in the EU decreased over recent years and the projections are favorable. Less favourable trends were observed in eastern Europe, though starting from relatively low rates. Testicular cancer mortality declined over time in most countries, however levelling off in northern and western countries, after reaching very low rates. Bladder cancer mortality trends were less favourable in central and eastern countries compared to northern and western ones. Kidney cancer mortality reported a slight increase in men and stable rates in women over the last decade in the EU. To sum up, over the last four decades, mortality from prostate, testis, and bladder cancers but not from kidney cancer, declined in most European countries. Prostate cancer mortality rates remain lower in Mediterranean countries than in northern and central Europe. Rates for all urologic cancers remain higher in central and eastern Europe. I wrote a book chapter on the epidemiology of prostate cancer, including all the aspects I studied for my PhD.
In addition, I published as a co-author other papers on mortality over time and prediction analysis focusing on different aspects and various cancer mortality causes: mortality from soft tissue sarcomas, childhood cancer mortality, colorectal cancer mortality in young adults, and mortality from gastric and esophageal cancer, and differences between eastern and western EU cancer mortality. I submitted an abstract for the Africa Mortality Symposium on mortality cancer trends in the Republic of South Africa, the Republic of Mauritius, and Réunion and I am currently working on European prediction of cancer mortality rates for 2023. The research group I work has been publishing cancer mortality predictions annually since 2011.
Moreover, during these three years, I was involved in the CEFIC project (PI Prof. Negri from University of Bologna) titled “Incidence trends of selected endocrine-related diseases and conditions in Europe and North America, and the contribution of changes in human reproduction”. Among the endocrine-related diseases and conditions, there were four cancer sites considered: endometrium, breast, testis, and prostate. I gave my contribution to this project by evaluating the cancer incidence trends in high-income countries worldwide and reviewing the association between selected reproductive factors and the selected cancers. Thus, we investigated changes in relevant reproductive factors and estimated their influence on cancer occurrence.
During my PhD, I have been collaborating with the department of Oncology at the Mario Negri Institute. Under the supervision of Dr Bosetti I have worked on various projects. In particular, I was involved in updating of a meta-analysis concerning aspirin use and the risk of twelve solid tumors with a dose-response analysis finalizing three publications. Moreover, the Mario Negri Institute manages the Italian Register of Multiple Sclerosis, collecting data from more than 100 Italian centers including more than 70.000 patients. Based on this real-world dataset, I have dealt with several aspects related to multiple sclerosis, being involved in the drafting of two papers one concerning two methods for measuring the disability accumulated over time and another one studying patients’ and referral centers’ characteristics in relation to multiple sclerosis phenotypes.
In my last PhD year, I worked at the Department of Quantitative Methods and Economics of the University of Las Palmas supervised by Prof. Serra-Majem for nine months. This training period aimed to gain new experience in conducting cost-effectiveness studies. I conducted a study aimed to quantify the over cost due to obesity among patients hospitalized for Covid-19. In collaboration with the Department of Public Health, I conducted an effectiveness analysis of a primary prevention intervention with a Mediterranean diet supplemented with extra-virgin olive oil or nuts using the data from PREDIMED Trial. Lastly, I took part in the WOMEDS Study, a project aimed to analyse gender inequality among medical doctors in Spain. During these months abroad, I co-wrote three papers, currently under revision
The Philosophy of Social Market Economy: Michel Foucault's Analysis of Ordoliberalism
No full textMichel Foucault’s lectures at the Collège de France in 1978–1979 centered on the analysis of power with regard to liberalism. Foucault especially focused on German ordoliberalism and its specific governmentality. Although Foucault’s review of the ordoliberal texts, programs, and books is very faithful, there are some occasional “schematic” simplifications. Our paper will evaluate Foucault’s constitution of an ordoliberal “archive”, though more emphasis will be put on the general importance of the phenomenological orientation in Walter Eucken’s work. Hence, three tasks will guide our paper: first, an analysis of Foucault’s position; second, the phenomenological foundation of the ordoliberal discourse compared to the 18th century liberal discourse, i.e. the way in which Walter Eucken received Husserl. Third, our paper shall raise the subject of the mutual historical-epistemological complementation of philosophy and economics by taking Foucault’s analysis as the starting point. Furthermore, the consequences of a phenomenological, “eidetic” order of the economy will be discussed, focusing mainly on the expansion of competition in social domains. --Foucault,Husserl,Eucken,ordoliberalism,eidetic order of the market,social market economy
