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    An Analysis of Fertility Determinants in Pakistan. The Role of Education and Intimate Partner Violence
    (Università della Calabria, 2025-05-30) Afreen, Khawar; Piluso, Fabio; Ordine, Patrizia; Rose, Giuseppe
    The manuscript consists of three chapters. The initial chapter stems from the need to understand the association between women's education and fertility in Pakistan. The Pakistan Demographic Health Survey (PDHS) 2017-2018 is the basis for the study in all three chapters. Pakistan is one of those nations that is suffering from the complications of higher fertility and lower levels of education and struggling to improve these demographic factors. In any country, education is considered the reason to control fertility levels. To shed some light on the importance of this fact, educational attainment and the total children ever born have been considered to examine the relationship of education with fertility for women. Due to the nature of the response variable, children ever born, which is a count variable, Poisson regression was used. The results provide evidence that women with secondary and higher education have a negative and significant association with fertility and thus support the hypothesis that educated women have lower fertility. Women with secondary and higher education have fewer children compared to women with no education, while female education at the primary level did not significantly affect fertility in the research. Furthermore, the age of first cohabitation, age at first birth, and wealth index were revealed to be significant determinants of fertility. The focal point of the second chapter revolves around the use of Pakistan's Article 25(A). This research gives new evidence on the effect of female education on fertility in Pakistan, focusing on changes in secondary and primary school law as the source of exogenous variations in education. This policy change affected all individuals born on or after May 2014, February 2013, June 2013, and December 2012 in Punjab, Sindh, Balochistan, and the Islamabad region, respectively. Applying the local randomization technique, we create a natural framework for analyzing a regression discontinuity design with a discrete running variable and few mass points. Our findings show that there is a discontinuity in the outcome variable (total number of children ever born and women's age at first birth) at the cutoff point and indicate a clear jump in the observed values for all regions. As a result of national-level reforms, increases in education do not reduce the number of children born per woman in Punjab and Balochistan, and the adoption of compulsory primary and secondary schools does not increase educational attainment while fertility decreases due to family planning practices in Sindh and Islamabad. The final chapter aims to extend the literature about how intimate partner violence increases the risk of high fertility behavior in Pakistan. Intimate partner violence (IPV), a devastating consequence of gender inequality in society, is the most common type of IPV, with intimate partners perpetrating the majority of abuse and causing serious health repercussions for women. Women who have experienced abuse are also at a greater risk of reproductive health effects, inconsistent and poor levels of contraceptive usage, unwanted pregnancies, and unfavorable pregnancy outcomes. Pakistan remains with a high fertility rate, despite several programs and policies aimed at attaining significant fertility reductions in the region. This research examines whether women's exposure to domestic violence is a contributing factor to increased fertility in Pakistan. A weighted sample of 3,416 currently married women in Pakistan was analyzed. Our dependent variable is the total number of children ever born, which is the proxy of fertility, and the main explanatory variable is intimate partner violence (physical, emotional, and sexual). An instrumental variable Poisson generalized method of moments estimator was used in estimating the model. Our findings support the hypothesis that women who have experienced domestic violence have greater fertility rates compared to those who have not.
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    The Role of Performance Reports and Financial Health for Value Creation in Healthcare System: A Case Study of NHS East Kent, UK and ASP Cosenza, Italy
    (Università della Calabria, 2025-05-07) Rashid, Tahani; Raniolo, Francesco; Nardo, Maria Teresa; Samà, Antonio
    Value creation is the most debatable topic in healthcare in recent decades. The present study is descriptive in nature; two case studies were investigated—East Kent Hospitals University NHS Foundation Trust (EKHUFT), UK, and Provincial Health Authority (ASP) Cosenza, Italy—to examine the comparative performance and financial analysis of the healthcare frameworks over an 8-year period from 2015 to 2022. The research explores thematic priorities in sustainability, technological innovation, and training by ensuring the system’s high quality service delivery and operational eViciency, along with financial stability, which is critical for value creation in any healthcare system to achieve long-term goals. This study employs a mixed-method approach by integrating keyword trend analysis and financial ratio assessment to provide a comprehensive understanding of how healthcare delivery systems prioritize strategic initiatives, navigate challenges, and allocate resources. This study demonstrates the significant diVerences in the thematic focus of each healthcare system and their value creation. NHS East Kent represents a structured approach towards the variables, including sustainability, technological innovation, and training, underscoring its commitment to long-term goals. In contrast, the ASP Cosenza struggles with multiple challenges like workforce shortages, resource constraints, and delays in implementing structured and consistent strategies. Despite these challenges, it showed commitment to address regional healthcare needs. ASP Cosenza took the initiative to implement renewable energy projects and prepare its hospitals for emergency response training. This thesis highlights various limitations, particularly in ASP Cosenza, including the use of scanned image files, data gaps, and untimely publication in their database. Nevertheless, adapting advanced analytical methods gives valuable insight for policymakers and healthcare governments to take the initiative to deal with upcoming challenges. The findings emphasize that a stable, eVicient, and resilient healthcare system can serve as a driver for value creation. By identifying the gaps, the study oVers a framework for evaluating thematic priorities and financial discourse to add value to healthcare.
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    MESOPOROUS SILICA NANOPARTICLES FOR THE SELECTIVE DELIVERY OF DOXORUBICIN TO FOLATE RECEPTOR- EXPRESSING CANCER CELLS
    (Università della Calabria, 2025-05-29) Longobucco, Camilla; Sisci, Diego; Catalano, Stefania
    Breast and cervical cancers significantly impact women's health globally, with breast cancer accounting for approximately 2.3 million new cases annually. This highlights the urgent need for targeted therapeutic strategies that effectively eliminate tumor cells while preserving normal tissues. In this study, we developed a mesoporous silica-based nanodevice, FOL-MSN-DOXO, designed for the localized delivery of the chemotherapeutic agent doxorubicin (DOXO). This nanodevice utilizes the acidic tumor microenvironment for drug release via an acid-labile bond and incorporates folic acid (FOL) to enhance uptake by folate receptor-expressing cancer cells (FR+). The efficacy of FOL-MSN-DOXO was evaluated through various in vitro assays, including fluorescence-activated cell sorting (FACS), growth assays, and ROS measurements, as well as immunostaining of dorsal root ganglia (DRG) cells from neonatal rats. Our results demonstrate that FOL-MSN-DOXO effectively induces apoptosis in FR+ cancer cells (e.g., HeLa and T-47D), while exhibiting minimal toxicity towards FR3 normal cells (3T3-L1 and BJhTERT). Conversely, free DOXO exhibited significant toxicity across all tested cell lines. Notably, FOL-MSN-DOXO reduced neuronal toxicity compared to free DOXO, underscoring its neuroprotective potential. In summary, FOL-MSN-DOXO offers a promising targeted drug delivery system that selectively induces cytotoxicity in FR+ cancer cells while sparing normal tissues. This approach mitigates the neurotoxic effects associated with doxorubicin, highlighting the efficacy and safety of folic acid-functionalized mesoporous silica nanoparticles in cancer treatment.
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    Methods and strategies for the synthesis of biologically active oligopeptides and small molecules for potential applications in the field of drug delivery
    (Università della Calabria, 2025-01-21) Cavallaro, Palmira Alessia; Catalano, Stefania; Leggio, Antonella
    My PhD research activity focused on the development of novel methods and strategies for synthesizing biologically active short-chain peptides and piperazine-based small molecules, as well as designing mesoporous silica-based nanocarriers capable of incorporating and transporting these compounds, with the aim of enhancing their therapeutic potential. The main activities carried out during my PhD research were as follows: • Development of a novel peptide synthesis method for the production of small peptides in the solution phase. This approach combines TiCl4 as a condensing agent with microwave heating, enabling the rapid and efficient formation of dipeptide systems with urethane protecting groups on the N-terminal amino group. • Design and synthesis of a new cyclic somatostatin analog, c(-FWKTE-), using microwave-assisted solid-phase peptide synthesis (SPPS) and Fmoc chemistry. This cyclic pentapeptide includes the biologically active 7-10 sequence of somatostatin and glutamic acid at the C-terminus. Preliminary in vitro tests were carried out to explore its antiproliferative activity against breast cancer cell lines. • Design and synthesis of a novel class of piperazine-based molecules as potential inhibitors of the NS2B/NS3 protease in Flaviviridae viruses, including Zika and Dengue. These compounds, incorporating urea, sulfonamide, and acyl functional groups, were evaluated for antiviral activity through live-virus assays in human hepatoma cells. Furthermore, the anticancer potential of these piperazine derivatives was investigated in breast cancer cell lines. • Development of mesoporous silica-based (MSN) nanodevices with a dual architecture. featuring targeting molecules on their external surface and linkers within the pores for subsequent drug anchoring via covalent and non-covalent interactions. These nanocarriers are designed to enhance the therapeutic efficacy of the synthesized compounds by improving their delivery and bioavailability. The surface properties of these systems were analyzed to assess the impact of different modifications on the nanoparticle surface structure and their potential for novel applications. This thesis includes published works, studies ready for submission, and ongoing research that requires further investigation before completion and publication.
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    APPLICATIONS OF ANSWER SET PROGRAMMING TO LINEAR TEMPORAL LOGIC OVER FINITE TRACES
    (Università della Calabria, 2025-01-08) Ielo, Antonio; Terracina, Gorgio; Ricca, Francesco; Dodaro, Carmine
    Linear Temporal Logic over Finite Traces (LTLf) is a popular logic to express high level specifications that require reasoning about time. It was introduced in the seminal work of De Giacomo and Vardi, motivated by the fact that many Artificial Intelligence applications that require temporal reasoning are more intuitively described as finite execution sequences, rather than infinite execution sequences as in Linear Temporal Logic. Due to the high complexity that characterizes LTLf-related problems, efficienty systems are required. Reasoning tasks in LTLf are usually tackled by automata theoretic techniques or by SAT-based approaches. This thesis proposes an alternative approach to LTLf-related reasoning problems that is based on Answer Set Programming (ASP). Answer Set Programming is a declarative logic programming paradigm that stems from research in stable model semantics for logic programs and knowledge representation and reasoning. ASP is more expressive than SAT, thus, the solutions we obtain are more compact, intuitive and readable than SAT counterparts; moreover the usage of ASP does not result in a compromise on efficiency and effectiveness. Indeed, the approach presented in this thesis often obtains better performance with respect to existing SAT-based solutions; also, ASP enabled the development of novel solutions for unsatisfiable core enumeration and query checking in declarative process mining contexts.