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We investigate the long-run growth of Europe in the world economy. The research covers the first half of the xxist century. The basic trends that will shape the growth regime in the global economy are the demographic transition and the diffusion of technological progress. We use the framework of ingenue, an olg model that divides the world in ten broad regions. Hypotheses are elaborated on the basic trends and discussed in an historical perspective. Structural changes are then introduced into ingenue to make prospective scenarios.A baseline scenario is built to outline the main macroeconomic features of the broad regions. This scenario being used as a benchmark is deliberately conservative as far as structural and institutional changes are concerned. It depicts Western Europe as an ageing low-growth region, accumulating net foreign assets and enjoying an appreciating real exchange rate. These are the characteristics of a permanent creditor in a world growth regime supported by capital mobility.The frontiers of Europe are investigated in the last part of the paper by means of two alternative scenarios. First it is assumed that eu enlargement accelerates the technological catch-up of Eastern Europe and boosts growth. Second labour mobility is simulated. Because the cost of financing public retirement is higher in Western Europe, a policy of immigration is implemented to eschew the decline of the labour force. Both the beneficial effects on Western Europe and the adverse effects on the regions of emigration are displayed. ; Nous explorons la croissance tendancielle de l'Europe au sein de l'économie mondiale. La recherche couvre la première moitié du xxie siècle. Les principaux facteurs du régime de croissance vont être la transition démographique et la diffusion du progrès technique. Nous utilisons le modèle ingenue qui découpe le monde en dix grandes régions. Des hypothèses sont formulées sur ces facteurs et discutée dans une perspective historique. Les changements structurels impliqués par ces hypothèses sont introduits dans ingenue pour faire des scénarios prospectifs.Un scénario de référence est construit qui décrit les principales caractéristiques macroéconomiques des grandes régions. Parce qu'il veut être la base à partir de laquelle sont étudiées des variantes, ce scénario est conservateur dans les changements structurels et institutionnels qu'il incorpore. Il décrit l'Europe occidentale comme une région vieillissante à croissance faible, qui accumule des actifs nets sur l'étranger et qui bénéficie d'une appréciation réelle de l'euro. Ce sont les caractéristiques d'un créancier permanent qui tire parti de la mobilité du capital.Deux scénarios illustrent les frontières de l'Europe. D'abord, on suppose que l'élargissement vers l'Est accélère le rattrapage technologique de l'Europe de l'Est et donne une impulsion à la croissance. Ensuite, on simule une politique d'immigration en Europe de l'Ouest pour compenser le déclin de la population active et modérer l'augmentation du coût du financement public des retraites. Le modèle met en évidence et quantifie les effets bénéfiques en Europe de l'Ouest et les effets contraires dans les zones d'émigration.

We investigate the long-run growth of Europe in the world economy. The research covers the first half of the xxist century. The basic trends that will shape the growth regime in the global economy are the demographic transition and the diffusion of technological progress. We use the framework of ingenue, an olg model that divides the world in ten broad regions. Hypotheses are elaborated on the basic trends and discussed in an historical perspective. Structural changes are then introduced into ingenue to make prospective scenarios.A baseline scenario is built to outline the main macroeconomic features of the broad regions. This scenario being used as a benchmark is deliberately conservative as far as structural and institutional changes are concerned. It depicts Western Europe as an ageing low-growth region, accumulating net foreign assets and enjoying an appreciating real exchange rate. These are the characteristics of a permanent creditor in a world growth regime supported by capital mobility.The frontiers of Europe are investigated in the last part of the paper by means of two alternative scenarios. First it is assumed that eu enlargement accelerates the technological catch-up of Eastern Europe and boosts growth. Second labour mobility is simulated. Because the cost of financing public retirement is higher in Western Europe, a policy of immigration is implemented to eschew the decline of the labour force. Both the beneficial effects on Western Europe and the adverse effects on the regions of emigration are displayed. ; Nous explorons la croissance tendancielle de l'Europe au sein de l'économie mondiale. La recherche couvre la première moitié du xxie siècle. Les principaux facteurs du régime de croissance vont être la transition démographique et la diffusion du progrès technique. Nous utilisons le modèle ingenue qui découpe le monde en dix grandes régions. Des hypothèses sont formulées sur ces facteurs et discutée dans une perspective historique. Les changements structurels impliqués par ces hypothèses sont introduits dans ingenue pour faire des scénarios prospectifs.Un scénario de référence est construit qui décrit les principales caractéristiques macroéconomiques des grandes régions. Parce qu'il veut être la base à partir de laquelle sont étudiées des variantes, ce scénario est conservateur dans les changements structurels et institutionnels qu'il incorpore. Il décrit l'Europe occidentale comme une région vieillissante à croissance faible, qui accumule des actifs nets sur l'étranger et qui bénéficie d'une appréciation réelle de l'euro. Ce sont les caractéristiques d'un créancier permanent qui tire parti de la mobilité du capital.Deux scénarios illustrent les frontières de l'Europe. D'abord, on suppose que l'élargissement vers l'Est accélère le rattrapage technologique de l'Europe de l'Est et donne une impulsion à la croissance. Ensuite, on simule une politique d'immigration en Europe de l'Ouest pour compenser le déclin de la population active et modérer l'augmentation du coût du financement public des retraites. Le modèle met en évidence et quantifie les effets bénéfiques en Europe de l'Ouest et les effets contraires dans les zones d'émigration.

Abstract
Trucking is a key industry in Canada with around 180 000 professional drivers. As an industry it has a disproportionately high injury claim rate, particularly for back injuries. Whole-body vibration (WBV) can contribute to the onset and development of low back disorders, and is a well-documented exposure among driving professions. A widely adopted WBV mitigation measure focuses on hydraulic and/or pneumatic passive suspension systems both in the driver's seat and underneath the vehicle cab. Passive suspension 'air-ride' seats are the current industry standard but new technologies such as the electromagnetic active vibration cancelling (EAVC) seats offer potentially substantial improvements in WBV reduction. In this paper, we evaluate and compare four commonly used truck seats (three air-ride, one EAVC) for their vibration damping characteristics and WBV exposure attenuation in on- and off-road conditions. We recruited 24 professional truck drivers who drove 280 km (mixed on-road and off-road) in ore-haul trucks under four different seating conditions. Following the ISO 2631-1 WBV standard, vibration measurements were made on the cab floor and seat pad, and 8-h average weighted vibration (A(8)) and 8-h vibration dose values (VDV(8)) were calculated, as well as the Seat Effective Amplitude Transmissibility (SEAT), and daily vibration action limits (DVALs). These measures were compared between seat types, as well as road conditions. The EAVC seat gave best performance for both A(8) (0.27 m s−2) and VDV(8) (6.6 m s−1.75). The EVAC seat had the lowest SEAT tested (36.2%) and the longest DVAL. However, among the three passive air-suspension seats, two showed significantly reduced A(8) (0.43 and 0.44 m s−2) and VDV(8) (9.1 and 9.3 m s−1.75) exposures relative to the third passive air-suspension seats [A(8) (0.54 m s−2) and VDV(8) (11.1 m s−1.75)]. These differences in exposures among the three passive air-suspension seats resulted in varying DVAL times, with the worst performing seat reaching the DVAL after only 6.3 h of driving. There was also a seat by road type interaction; there were performance differences between the passive air-suspension seats on-road, but not off-road. The observed reduction of the WBV exposures measured from the EAVC seat was consistent with previous results. But we showed that there can also be substantive differences among seats that are the current industry standard. These differences were more evident on-road than off-road, which suggests that more work needs to be done to understand seat performance characteristics, and in matching the correct seat technology to the driving task. We demonstrated that WBV exposures in current industry conditions may exceed health-based exposure limits; this has policy relevance because WBV exposures are linked to prevalent and costly adverse health conditions in a working population that is ageing. Increased WBV measurement collection is recommended to ensure the anticipated exposure attenuations are achieved when seats are relied upon as an engineered control against WBV.

Tutkimus käsittelee sitä, miten vanhat ihmiset puhuvat omasta vanhenemisestaan ja terveydestään sekä vanhuudesta ja terveydestä yleensä. Erityisenä kiinnostuksen kohteena oli, millaisena osallistujat näkivät vanhojen ihmisten sosiaalisen aseman yhteiskunnassa ja suhteessa nuorempiin ihmisiin. Toiseksi tutkimuksessa selvitettiin sitä, mitä ajatellaan yksilön vastuusta ja mahdollisuuksista vaikuttaa terveyteen omilla toimillaan ja valinnoillaan. Aineistona oli 90 vuotta täyttäneiden pirkanmaalaisten miesten ja naisten elämäkerrallisia haastatteluja ja 70 vuotta täyttäneiden tamperelaisten miesten ja naisten ryhmäkeskusteluja. Tutkimus osoitti, että vanhan ihmisen sosiaalinen asema näyttäytyi ongelmallisena. Monet kokivat, että vanhat ihmiset nähdään ulkopuolisina ja tarpeettomina yhteiskunnassa. Osa kritisoi tätä näkemystä ja toi esille erilaisia tapoja miten he itse toimivat omassa lähipiirissään ja yhteisössään ja omalta osaltaan auttavat muita ihmisiä. Yleinen kokemus oli myös se, että tietyn iän ylittäneet ihmiset nähdään ja heitä kohdellaan yhtenä vanhojen ryhmänä, ja sivuutetaan yksilölliset erot ihmisten välillä. Suhteessa nuorempiin ihmisiin monien kokemus oli se, että heitä kohdellaan holhoavasti lapsina , joiden puolesta tehdään päätöksiä. Toisaalta tutkittavat toivat esille, että pitkä elämä tuo väistämättä elämänkokemusta, jota nuoremmilla ei voi olla. Tällaiseen puheeseen liittyi yleensä laajaa perustelua ja argumentointia, mikä voi kertoa siitä, että vanhat ihmiset itse kokevat ettei näkemys vanhuudesta viisautena ole elettyä todellisuutta nykykulttuurissa. Tutkittavat tasapainoilivat kahden näkemyksen välillä: onko vanhuus lainomainen kohtalo, johon ei voi itse vaikuttaa muuten kuin sopeutumalla terveyden heikkenemiseen ja menetyksiin, vai onko niin, että omilla teoilla ja valinnoilla voi vaikuttaa omaan terveyteensä ja siihen millaista elämä vanhana on? Vanhuuden kokemukseen liitettiin terveysongelmat ja se ettei enää selviä omillaan ja tarvitsee muiden apua. Huononevan terveyden koettiin johtavan eristyneisyyteen muista ihmisistä, yksinäisyyteen ja jopa unohdetuksi tulemiseen. Vanhuus ei tule yksin - tyyppiset sanonnat kiteyttävät ajatuksen siitä, että vanhuus on kaikille yhteinen kohtalo, johon ei voi vaikuttaa. Toisaalta tuotiin esille, että omaan elämään ja terveyteen vanhana voi ja on syytä yrittää vaikuttaa omilla toimillaan. Keskeisinä keinoina vaikuttaa terveyteen nähtiin fyysinen ja sosiaalinen aktiivisuus sekä kaikenlainen aivovoimistelu . Lisäksi monet kertoivat terveellisistä elintavoistaan. Useat niistäkin, jotka kertoivat terveyden heikenneen, kertoivat pyrkivänsä huolehtimaan terveydestä ja olleensa aktiivisia ja omatoimisia aikaisemmin. Aktiivisuuden ideaali koskee näiden tulosten mukaan myös hyvin vanhoja ihmisiä. Tulokset viittaavat myös siihen, että julkisissa keskusteluissa usein käsitellyt terveysteemat ovat osa vanhojen ihmisten terveyttä koskevaa ajattelua. Yhteenvetona tuloksista voi todeta, että yhtäältä terveyden ja toimintakyvyn huononeminen vanhuudessa ja elämän rajallisuus koetaan pakkona, johon on sopeuduttava. Toisaalta koetaan että ihminen ei ole vain lastu laineilla , vaan voi itse jossakin määrin vaikuttaa omaan terveyteensä ja siihen millaista elämää vanhana elää. Tutkimus osoitti, että vanhuuden kokemus on monitasoinen ilmiö. Tutkittavat puhuivat paljon itsenäisyydestä ja omillaan pärjäämisestä ja siitä, että ainakin yritetään selvitä itse ja yksin. Toive olla hyväkuntoinen ja terve on varmaankin kaikille yhteinen iästä riippumatta, mutta miksi avuntarvetta ylipäätään pitää perustella? Nykyisissä yhteiskunnallisissa keskusteluissa korostetaan paljon yksilön mahdollisuuksia vaikuttaa terveyteen ja vastuullisuutta omasta elämästä. Tutkimustulosten pohjalta voi herättää keskustelua siitä, onko aktiivisuudesta ja terveydestä huolehtimisesta, sekä yksin ja itse pärjäämisestä tullut jo moraalinen vaade nyky-yhteiskunnassa? Tätä taustaa vasten ajatus vanhuudesta lainomaisena kohtalona, joka aiheuttaa terveyden heikkenemisen ja kohtaa kaikkia samalla tavoin, voikin auttaa yksilöä oikeuttamaan ja hyväksymään avuntarpeen, ja sen, ettei enää kykene huolehtimaan terveydestään. Mutta toisaalta on tärkeää tuoda esille myös se, että terveyteen vanhuudessa voidaan vaikuttaa ja vanhat ihmiset ovat myös aktiivisia ja omatoimisia. Tämä näkemys auttaa kyseenalaistamaan näkemyksen vanhuudesta vain ja ainoastaan raihnautena ja yhteiskunnasta irtaantumisena. ; In this research the aim was to find out how old age and health are discussed by people who themselves are seen and treated as old. Its focus was to study these people s talk about their experiences of old age and health. While I do not believe that other people s experiences are directly available for us to discover, it is still important to analyse what kinds of elements are included in people s talk about their experiences and in their self-identities. This information will help gain a deeper understanding of how being old and health are perceived by those people who may see themselves, and who are seen and treated by others, as ageing or old. The focus of the research was to identify the different perspectives raised by people in their talk and to find out how those perspectives were used in talk. The research questions were concerned with how people defined old age and being old as a social position, in relation to other people and in the context of one s own life entity, and with what meanings health received in this context. I was particularly interested to learn how people talked about their own and other people s chances to influence their health and ageing, and whether they felt that people were responsible for their own health. The theoretical framework for the research was underpinned by social constructionism and the discursive perspective, which entail the idea that talk is action. The datasets consisted of biographical interviews with people aged 90 or over and group discussions in which the participants were 70 years or over. The main tools of analysis came from discourse and rhetoric analysis. These ! methods made it possible to study how diff erent arguments were used in talk to explain, defend and legitimate one s own decisions and actions as well as other people s actions. The research findings showed that it is too simplistic to talk about the experience of old age in terms of denying age or resisting negative stereotypes of old age. Rather, older people have various ways of thinking about and defining old age and health. Being old is an ambivalent position. Mobilizing the category of old age in talk about oneself seemed to make the agentic position problematic. In their talk about old age and health, the people in this study balanced between different views and ways of talking. I called these different ways of talking the decline, activity and wisdom discourse. Discourses are cultural resources that people use to construct meanings of old age and health and their own identity as old. In the decline discourse, the participants in this study constructed old age as self-evidently a time of poor health and losses, which serve to explain and legitimate ill health,dependence on other people and need for help. The activity discourse was used to construct old age as something the individual can choose and have an influence on. It was used to construct oneself as active, healthy, a needed member of society and independent. Within the activity discourse, health was constructed as something that is malleable by means of one s own actions and as a matter of individual responsibility. On the other hand, the participants qualified the idea of responsibility by mentioning various factors that are beyond the individual s influence. Talk about old age as wisdom was the weakest discourse in this data, possibly indicating that that there is little real support for the idea that old age is seen in society as a time of wisdom and that older people represent that wisdom. The most important discovery, however, was that these different discourses were used by the same people to give meaning to and construct their identities. These discourses were also contrasted with one another, but talk about old age is best described in terms of negotiation and renegotiation about one s positions and the meaning of one s own actions and decisions. Both old age and health talk involved moral argumentation. People s talk revolved around chances to influence one s own health and life in old age, and on the other hand, around the question of how far old age is a fate that is beyond individual influence. I approached the interviews and group discussions as interaction situations in which both interviewer and interviewee are active participants. Individual interviews place more pressure on the individual interviewee. Health proved to be a particularly dilemmatic topic in this regard because of the heavy ideological and moral baggage it carries in contemporary western culture, and talk about one s own health can present a threat to one s face. A common concern in individual interviews was to explain and justify one s own health-related choices and actions. Various discursive and rhetorical devices were applied to construct one s own activity and good health. The research showed that the group discussions involved more negotiation between different views. Sensitive and conflicting views were also raised in group discussions. In other words this research did not support the view that group discussions are conducive to unitary views and discourage talk about sensitive issues. The social constructionist view on reality and social facts is that for analytical reasons, it is important to look at the meanings given to old age and health by older people themselves. This does not mean to say that social constructionist research ignores social facts , structures, bodily being or power relations. These, too, can be made a topic of analysis in order to see whether and how they become visible, are made a meaningful and important part of one s own ageing. Rhetorical studies provide a powerful tool for exploring the argumentative basis of age categories and identities. Rhetoric analysis, importantly, pays attention to how talk about old age and health is a presentation of identity and a way of constructing an accountable and worthy identity. The particular benefit of this enterprise is that it allows us to study the arguments applied in making some versions of reality look more plausible or better and to ignore or silence other versions. Discursive studies have demonstrated their strength in showing how one and the same person can use diff erent and even conflicting age categories and discourses, and how the meaning of the topic at hand is constructed in interaction, negotiated and accepted or refuted. Both discursive and rhetorical analysis provide tools for studying the ideological and moral meanings of old age and health an important topic in times when health seems to carry strong ideological and moral connotations, and when the growth of the elderly population is repeatedly brought up in public debate. I see that constructionist and discursive studies have a crucial role to play in ageing research in addressing the different ways in which old age is made reality physiological, political or experiential and in studying what is achieved with different versions of reality. What kind of identities, politics, services, demands of individual conduct do they make appear natural, inevitable and reasonable, or alternatively, unnatural, avoidable, impossible and irrational? How is age used to classify and categorize people into different sites of everyday life? How individual and groups themselves use different age categories and whether and how these are linked to social and political rights and valued or devalued social positions? How category of old age is used either to enable agency or what type of reasons and justifi cations are used to curtail people s potential? How do older people see their prospects of enacting agency? Some of the topics were approached in this study. All of these deserve further research.

Emphasizing the significant socio-demographic changes of the last decades (family transformation and ageing of modern societies), the capability of family to perform some of its essential functions (i.e., care for the elderly) and to maintain solidarity between generations is being questionned both in academic and social policy discourse. Statistical and socio-demographic research data show that the processes related with deinstitutionalisation of a family and a rapid increase in the number of elderly people are observed in Lithuania as well. This indicates a relevance of the questions raised by Western sociologists regarding the fragmentation of social and personal ties and modification of relationships between generations (both "within" and "outside" a family) to the national context. The article explores the peculiarities of intergenerational communication in Lithuanian families, aiming to reveal the frequency of contact between parents and children, patterns of their interaction and emotional closeness—the dimensions that are crusial to an understanding of the intergenerational solidarity, exchange and support in a family. Analysis is based on the data of questionnaire survey of the Lithuanian population representing four age cohorts (persons born in 1950-1955, 1960-1965, 1970-1975 and 1980-1985, N=2000), carried out in 2011-2012. The methodology of conducted quantitative research is discussed in the first chapter; the second chapter presents analysis of empirical data. Conducted research provides evidence of maintenance of regular communication between respondents and their children/parents living apart, and reveals a more active women's role in interaction. Personal relationships are viewed commonly through emotional prism and are given, in overall, high evalution, thus indicating the strong bonds between generations in Lithuanian families. ; Atkreipiant dėmesį į reikšmingus socialinius-demografinius pastarųjų dešimtmečių pokyčius (šeimos transformaciją ir modernių visuomenių senėjimą), akademiniame ir socialinės politikos diskurse vis dažniau keliomos abejonės dėl šeimos galimybių atlikti kai kurias jos esmines funkcijas (senyvo amžiaus asmenų globą ir priežiūrą) bei išlaikyti solidarumą tarp kartų. Straipsnyje nagrinėjami bendravimo tarp kartų ypatumai Lietuvos šeimose, siekiant atskleisti kontaktų tarp tėvų ir vaikų ypatumus (jų dažnį, bendravimo būdus) bei emocinius ryšius, t. y. tuos tarpusavio sąveikos aspektus, kurie leidžia įvertinti kai kurias svarbias tarpgeneracinio solidarumo dimensijas bei paramos teikimą šeimoje. Tyrimo objektas: 1950–1985 m. gimimo kartoms atstovaujantys gyventojai. Analizė grindžiama anketinės apklausos, atliktos 2011–2012 m., duomenimis. Jos metu buvo apklausta 2000 respondentų, atitinkamai po 500 keturiose amžiaus kohortose (1950–1955, 1960–1965, 1970–1975 ir 1980–1985 m. gimimo), kurie buvo atrinkti, remiantis kvotine atranka pagal amžių, lytį ir gyvenamąją vietovę. Tyrimo dizainas ir instrumentas (klausimynas) parengti bendradarbiaujat su užsienio (Šveicarijos ir Portugalijos) sociologais, apklausos anketą sudarė penki klausimų blokai, apimantys daugiau nei 100 klausimų. Apklausos būdas – struktūruoti interviu respondentų namuose. Atlikto kiekybinio tyrimo metodologija pateikta pirmajame straipsnio skyriuje, antrajame aptariami duomenys, atskleidžiantys įvairius skirtingų kartų šeimos narių tarpusavio bendravimo aspektus. Tyrimo rezultatų analizė rodo, kad absoliuti dauguma (per 90 proc.) respondentų nuolat bendrauja su atskirai gyvenančiais savo vaikais ir tėvais, išlaikydami glaudžius asmeninius ryšius. Lyginant bendravimo su vaikais ir tėvais modelius, galima pastebėti kai kuriuos skirtumus (tėvai dažniau aplankomi jų namuose, bendraujant su vaikais aktyviau naudojamos šiuolaikinės informacinės technologijos). Aptariant subjektyvų santykių su savo vaikais ir tėvais vertinimą, dažniausiai pateikiamos nuorodos į tradicines asmeninių ryšių išraiškos formas (pvz., gimtadienio sveikinimus) bei pritariama tvirtinimams, jog šie ryšiai teikia teigiamas emocijas. Ryšiai su vaikais yra vertinami kiek aukščiau, kas gali atspindėti ne tik tarpusavio santykių būklę, bet ir tam tikrus socialiai determinuotus tėvų lūkesčius vaikų atžvilgiu. Tyrimas atskleidė aktyvesnį moterų vaidmenį skirtingų kartų šeimos narių interakcijos procese ir parodė, kad su savo tėvais glaudžiau tarpusavyje bendrauja tos pačios lyties asmenys (dukros-motinos ir sūnūs-tėvai).

Abstract The efficiency of public service provision has been a subject of debate for several decades. Discussions that are centred around whether public or private service provision is more efficient are still active around the world and also concern water and sewage services. Additionally, waterworks are facing tightening quality and environmental requirements, while ageing infrastructure and rapidly growing repair debt must also be addressed. This study aims to identify the actions that are required to improve waterworks performance without compromising service quality. The objective is to find both internal and external factors that will improve efficiency. Despite the clear pressure for new solutions, there is only a limited amount of research on the topic, which provides further justification for this study. This dissertation has adopted a case study approach with multiple data sources in order to provide as diverse, detailed and profound information regarding the Finnish water and sewage sector. Data sources such as interviews, questionnaire and publicly available financial data were used as a basis for analysis. The results of this study indicate that the external factors that influence the performance of waterworks include legislation, environmental issues, population density and municipal topography. When benchmarking different waterworks, it is important to understand that some of these conditions are case-specific. Waterworks cannot change the external factors but they must analyse them in order for them to operate optimally. Internal factors that waterworks managers and municipal owners can influence include the selection of a suitable ownership and governance model, the roles of different decision makers, the competence of board members, asset management practices, proper maintenance of infrastructure, and operational and financial transparency. This study emphasises that municipal owners should concentrate on ownership policy and focus on their role as owners, not as operational managers. The selection of waterworks board members should prioritise management and engineering expertise. Legislators could help improve the efficiency of waterworks by promoting transparency and requiring uniform reporting practices. Making key information publicly available would enable benchmarking and planning of development activities. Waterworks managers should make long-term investment plans and systematically manage their assets. ; Tiivistelmä Julkisen palvelutuotannon tehokkuus on puhuttanut tutkijoita ympäri maailmaa jo vuosikymmenien ajan. Julkisen ja yksityisen palveluntuotannon eroista on keskusteltu monella sektorilla, niin myös vesi- ja jätevesihuoltopalveluissa. Vesihuollon kiristyvät laatu- ja ympäristövaatimukset, vanheneva infrastruktuuri ja nopeasti kasvava korjausvelka yhdessä tiukkenevien tehokkuusvaatimusten kanssa asettavat monet vesihuoltolaitokset ahtaalle. Tämän tutkimuksen tavoitteena on löytää toimenpide-ehdotuksia, joiden avulla vesihuollon suoristuskykyä voidaan parantaa kuitenkaan vaarantamatta palvelun laatua. Tavoitteena on löytää sekä sisäisiä että ulkoisia tekijöitä, jotka vaikuttavat vesihuollon suorituskykyyn ja joita muuttamalla vesihuollon tehokkuutta voidaan parantaa. Tämän väitöskirjan lähestymistapa on tapaustutkimus ja siinä hyödynnetään useita erilaisia tietolähteitä, jotta pystytään luomaan monipuolinen kuvaus tutkimuskohteesta. Analyysin perustana käytettiin erilaisia tietolähteitä kuten haastatteluja, kyselylomaketta sekä julkisesti saatavissa olevia taloudellisia tietoja. Tutkimustulosten mukaan vesihuoltolaitoksen suorituskykyyn vaikuttavia ulkoisia tekijöitä ovat muun muassa lainsäädäntö, ympäristölliset seikat, kunnan topografia sekä asukastiheys. Vesihuoltolaitokset eivät voi suoraan vaikuttaa ulkoisiin tekijöihin, mutta niiden tunnistaminen ja vaikutusten analysointi on tärkeää, jotta annetuissa puitteissa voidaan toimia optimaalisesti. Sisäiset tekijät, joihin vesihuoltolaitoksen johto ja kuntaomistaja voivat vaikuttaa, ovat sopivan omistus- ja hallintomallin valinta, eri toimijoiden väliset roolit, hallituksen jäsenten pätevyys, omaisuuden hallinta sekä operationaalinen ja taloudellinen läpinäkyvyys. Tutkimustulosten mukaan vesihuoltolaitoksen kuntaomistajan tulisi keskittyä omistajapolitiikkaan ja rooliinsa omistajana eikä operatiivisena johtajana. Vesihuoltolaitoksen johtokunnan ja hallituksen jäseniä valittaessa tulisi etusijalle asettaa liikkeenjohdollinen ja tekninen osaaminen. Avoimuuden edistäminen ja yhtenäisten raportointikäytäntöjen edellyttäminen ovat lainsäätäjän mahdollisia työkaluja vesihuoltolaitoksen tehokkuuden edistämiseen. Vesihuoltolaitoksen johdon tulisi tehdä pitkän aikavälin investointisuunnitelmia sekä systemaattisesti hallita vesihuoltolaitoksen omaisuutta.

Telomere length (TL) is a marker of ageing and mitochondrial DNA (mtDNA) is an early marker of inflammation caused by oxidative stress. We determined TL and mtDNA content among active pulmonary tuberculosis (PTB) patients to assess if these cellular biomarkers differed between artisanal miners and non-miners, and to assess if they were predictive of treatment outcome. We conducted a prospective cohort study from August 2018 to May 2019 involving newly diagnosed PTB patients at three outpatient TB clinics in a rural Democratic Republic of Congo. We measured relative TL and mtDNA content in peripheral blood leukocytes (at inclusion) via qPCR and assessed their association with PTB treatment outcome. We included 129 patients (85 miners and 44 non-miners) with PTB (median age 40 years; range 5-71 years, 22% HIV-coinfected). For each increase in year and HIV-coinfection, TL shortened by − 0.85% (− 0.19 to − 0.52) (p ≤ 0.0001) and − 14% (− 28.22 to − 1.79) (p = 0.02) respectively. Independent of these covariates, patients with longer TL were more likely to have successful TB treatment [adjusted hazard ratio; 95% CI 1.27 for a doubling of leucocyte telomere length at baseline; 1.05-1.44] than patients with a shorter TL. Blood mtDNA content was not predictive for PTB outcome. For a given chronological age, PTB patients with longer telomeres at time of diagnosis were more likely to have successful PTB treatment outcome. Pulmonary tuberculosis (PTB) kills almost 2 million individuals every year and is thus a leading cause of death among adults worldwide. Mycobacterium tuberculosis (Mtb) infects more than 10 million people each year 1-3. Mtb potently induces cytokines and chemokines from polymorphonuclear cells and monocytes, thus resulting in intense local inflammation in the lungs 4. Alveolar macrophages are anti-inflammatory in nature, but their function can be impaired by pollutants, including mineral dusts, thereby diminishing the body's ability to clear infections 5-8. This is probably why mineworkers are more susceptible to develop PTB. Telomere length (TL) reflects the history of oxidative stress and chronic inflammation, and is a marker for age-related disease susceptibility 9-12. In normal physiology, mitochondria are important in the cell as they generate most of the adenosine triphosphate (ATP) through the oxidative phosphorylation mechanism (OXPHOS), which is a critical energy supply for cellular processes and partially encoded with mitochondrial DNA (mtDNA). The OXPHOS mechanism uses dietary intake to produce ATP, but it also produces ROS which can destroy mitochon-drial DNA, impairs respiratory chain function and cause nuclear DNA damage 12-14. Further, Mitochondrial DNA (mtDNA) damage can result in genomic instability, cellular senescence and altered intercellular communication. Hallmarks of aging genomic instability and deregulated nutrient sensing can contribute to reduced mitochondrial OPEN ; Funding P.D.M.C.K was fellow of the Fonds Marc Vervenne of the KU Leuven (Belgium) and he is supported by the US National Institutes of Health (NIH)-Fogarty Postdoctoral Fellowship: Grant no. 1D43TW010937-01A1. D.S.M is a FWO postdoc, with funding number: FWO Grant 12X9620N. Fieldwork has been supported by the KU Leuven Alumni Association and the University of Antwerp-USOS via the CEGEMI of the Catholic University of Bukavu. The costs of measuring Telomere length and mtDNA were covered by a grant of the European Research Council (ENVIRONAGE). The funders had no role in the study design, data collection, analysis, interpretation, or writing of the report. The corresponding author had full access to all the study data and had final responsibility for the decision to submit for publication. Acknowledgements We thank Profs J. Balmes (UCSF), N. Lorent, E. André (KU Leuven), and C. Tonne (ISGlobal) for their critical appraisal of the manuscript. We are grateful to the study participants and their relatives, the TB clinics, and the DRC's National/Provincial TB and HIV programs for their collaboration.

In a joint statement with the UK and the USA on 19 December 2003, Libya publicly renounced nuclear, biological and chemical (NBC) weapons and agreed to restrict itself to the possession of ballistic missiles with a range of no greater than 300 km. In 2004 details of an informal nuclear weapon suppliers' network emerged and a new basis was provided for evaluating the proliferation assessments that governments had made in the past. A number of possible factors have been cited to explain Libya's decision to renounce NBC weapons and medium- and long-range missiles. Bush Administration officials have portrayed it as a vindication of the administration's robust approach to combating the spread of NBC weapons. However, there has been disagreement over whether -- or to what extent -- the administration's counter-proliferation strategy should be credited for Libya's decision. Some observers have described it as part of the Qadhafi regime's long-term diplomatic efforts to overcome two decades of political and economic isolation. Until 2004 Libya had been subjected to one of the most stringent of all UN sanctions regimes linked to its involvement in a number of violent incidents during the 1980s, for which it subsequently admitted at least partial responsibility. Before 2003-2004, public information about Libya's biological weapon- and nuclear weapon-related activities did not reflect the actual situation, while information regarding the country's missile program and, to a lesser extent, its chemical weapon (CW) program was more accurate. Until recently, most authoritative or official information regarding suspected Libyan NBC weapon and missile programmes was contained in status-of-proliferation reports and statements issued by the USA and other states. Some information was also released as a consequence of criminal proceedings against individuals and companies which had violated the sanctions regime. Libya has a modest civil nuclear infrastructure, centred on the Tajura Nuclear Research Centre (TNRC) near Tripoli. The TNRC is the site of a 10-megawatt (MW) research reactor that was completed with Soviet assistance in 1981 and placed under International Atomic Energy Agency (IAEA) safeguards. Libya received considerable foreign assistance to procure sensitive nuclear materials, technologies and components. Much of this assistance was provided by a sophisticated clandestine network run by Abdul Qadeer Khan, characterized by some as the 'father' of Pakistan's nuclear weapon program. Beginning in 1997, the Khan network supplied Libya with centrifuges and related components for an undeclared uranium-enrichment program. It also gave Libya documentation related to nuclear weapon design. However, the relatively low technical absorption capacity of Libya's scientific-industrial base meant that these 'short cuts' did not bring Tripoli appreciably closer to achieving a nuclear weapon capability. During the trilateral process, no concrete evidence of an existing biological weapon program was uncovered. The UK and the USA reportedly hold the view that certain agricultural and pharmaceutical facilities 'were established with biological weapons also in mind'. Libya declared 3,563 empty CW air bombs, 23.62 tonnes of sulphur mustard and more than 3000 tonnes of CW precursors. Libya stated that it had never transferred CW and declared that it had an inactivated CW production facility at Rabta and two CW storage facilities. The bulk of Libya's ballistic missile inventory consisted of ageing FROG and Scud-B missiles that had been imported from the Soviet Union. Libya's missile development was hampered by the imposition of UN sanctions between 1992 and 1999, which restricted the flow of ballistic missile technology. The country reportedly had some success in circumventing sanctions and obtaining missile-related components and technology from companies in China, India and the former Yugoslavia. In the 1990s, Libya also maintained cooperation with Iran in developing missile technology and components. It does not appear that Libya had an active program under way to develop a missile delivery system for nuclear warheads. In September 2004 the USA announced that its verification of the dismantling of Libya's NBC weapon programs, including 'MTCR-class missiles', was 'essentially complete'. Adapted from the source document.

The COVID-19 crisis has elicited an immediate and forceful economic policy response. With the height of the crisis behind us, the Governor has set out priority economic measures for the post-lockdown phase. He calls for the urgent launch of an ambitious, comprehensive, permanent and assessable strategy of structural reforms and fiscal consolidation. In this second, gradual-recovery phase, laying the foundations for sustainable and balanced growth will involve the economic policy response combining two objectives: to support the recovery and to provide for structural adjustment. And, in this scenario, public finances sustainability must be ensured. Three elements are needed to boost the credibility and effectiveness of this initial response and of the entire reform strategy. First, the fiscal expansion in the short term should go hand-in-hand with a plan to restore health to public finances in the medium term, once the economy resumes a sound growth path. Second, structural reforms should be expedited so they positively affect spending, investment and hiring decisions in the very short term. And third, political consensus must ensure the durability of the strategy over several legislatures. In the short run, the policies supporting the recovery should be attuned to the health situation and economic circumstances. That will involve maintaining monetary and financial measures geared to preserving appropriate access to financing. It will further entail extending and recalibrating income support and furlough schemes. New measures will also be needed, namely: active labour market and training policies for the unemployed; enhanced business restructuring and insolvency procedures; and a fiscal impulse for the restructuring of the productive system through investment in technological capital, education and training. In the medium term, the Spanish economy's main challenges will determine the structural reform agenda needed to increase our potential growth over the coming years. The paper details the measures on this agenda in response to each of the challenges identified: i) to improve productivity dynamics (promotion of business dynamics and growth, increased sectoral competition, enhanced human capital and an increase in technological capital); ii) to reduce unemployment and job insecurity (with a lower temporary employment ratio and active labour market policies); iii) to address population ageing (pensions system reform); iv) to bolster inclusion policies (minimum living income and housing affordability); v) to smooth the transition to a more sustainable economy (via fiscal policy and the financial system); vi) to maintain a healthy financial sector; vii) to tackle new challenges (globalisation and digitalisation); viii) to drive forward European governance reform (an appropriate European recovery fund, headway in the fiscal union, Stability and Growth Pact reform, completion of the Banking Union and a genuine Capital Markets Union); and ix) to ensure the sustainability of public finances (an ambitious multi-year fiscal consolidation programme). ; Una vez superada la etapa más aguda de la crisis del Covid-19, que ha supuesto una respuesta inmediata y contundente de la política económica, el gobernador plantea las medidas económicas prioritarias en la fase siguiente a la hibernación y la puesta en marcha, de manera urgente, de una estrategia ambiciosa, integral, permanente y evaluable de reformas estructurales y de consolidación fiscal. En esta segunda fase de reactivación paulatina, la respuesta de la política económica, para sentar las bases de un crecimiento sostenible y equilibrado, tiene que combinar dos objetivos: apoyar la recuperación y facilitar el ajuste estructural. Y, en ese escenario, la sostenibilidad de las finanzas públicas debe estar garantizada. Para potenciar la credibilidad y efectividad de esta respuesta inicial y de toda la estrategia de reformas: i) la expansión fiscal en el corto plazo debe presentarse acompañada de un plan de saneamiento de las cuentas públicas en el medio plazo, que procederá cuando la economía recupere una senda de crecimiento sólido; ii) las reformas estructurales deben acelerarse, para generar efectos positivos a muy corto plazo sobre las decisiones de gasto, inversión y contratación; iii) el consenso político debe garantizar la permanencia de la estrategia durante varias legislaturas. En el corto plazo, las políticas de apoyo a la recuperación deberán acomodarse a la evolución de la situación sanitaria y la coyuntura económica. Ello supondrá mantener medidas monetarias y financieras orientadas a preservar el acceso adecuado a la financiación, extender y recalibrar el sostenimiento de rentas y expedientes de regulación temporal de empleo, nuevas medidas, como políticas activas de empleo y de formación de los desempleados y mejores procedimientos de reestructuración e insolvencia empresarial, y un impulso fiscal a la reestructuración del tejido productivo a través de la inversión en capital tecnológico, educación y formación. En el medio plazo, los principales desafíos de la economía española inspiran la agenda de reformas estructurales que debe aumentar nuestro crecimiento potencial en el escenario de los próximos años. En el texto se detallan las medidas contenidas en esta agenda en respuesta a cada uno de los retos identificados: i) mejorar la dinámica de la productividad (fomento de la dinámica y el crecimiento empresarial, aumento del grado de competencia sectorial; mejora del capital humano e incremento del capital tecnológico); ii) reducir el desempleo y la precariedad del empleo (con menor temporalidad y políticas activas de empleo); iii) afrontar el reto del envejecimiento poblacional (reformas del sistema de pensiones); iv) reforzar las políticas de inclusión (ingreso mínimo vital y acceso a la vivienda); v) favorecer la transición hacia una economía más sostenible (desde la política fiscal y el sistema financiero); vi) mantener un sector financiero saneado; vii) afrontar los nuevos retos (globalización y digitalización); viii) impulsar la reforma de la gobernanza europea (un fondo de recuperación europeo adecuado, avances en la unión fiscal, reforma del Pacto de Estabilidad y Crecimiento, culminación de la Unión Bancaria y una verdadera Unión de Mercados de Capitales); ix) garantizar la sostenibilidad de las cuentas públicas (un ambicioso programa de consolidación fiscal plurianual).

We are witnessing an emerging digital revolution. For the past 25–30 years, at an increasing pace, digital technologies—especially the internet, mobile phones and smartphones—have transformed the everyday lives of human beings. The pace of change will increase, and new digital technologies will become even more tightly entangled in human everyday lives. Artificial intelligence (AI), the Internet of Things (IoT), 6G wireless solutions, virtual reality (VR), augmented reality (AR), mixed reality (XR), robots and various platforms for remote and hybrid communication will become embedded in our lives at home, work and school. Digitalisation has been identified as a megatrend, for example, by the OECD (2016; 2019). While digitalisation processes permeate all aspects of life, special attention has been paid to its impact on the ageing population, everyday communication practices, education and learning and working life. For example, it has been argued that digital solutions and technologies have the potential to improve quality of life, speed up processes and increase efficiency. At the same time, digitalisation is likely to bring with it unexpected trends and challenges. For example, AI and robots will doubtlessly speed up or take over many routine-based work tasks from humans, leading to the disappearance of certain occupations and the need for re-education. This, in turn, will lead to an increased demand for skills that are unique to humans and that technologies are not able to master. Thus, developing human competences in the emerging digital era will require not only the mastering of new technical skills, but also the advancement of interpersonal, emotional, literacy and problem-solving skills. It is important to identify and describe the digitalisation phenomena—pertaining to individuals and societies—and seek human-centric answers and solutions that advance the benefits of and mitigate the possible adverse effects of digitalisation (e.g. inequality, divisions, vulnerability and unemployment). This requires directing the focus on strengthening the human skills and competences that will be needed for a sustainable digital future. Digital technologies should be seen as possibilities, not as necessities. There is a need to call attention to the co-evolutionary processes between humans and emerging digital technologies—that is, the ways in which humans grow up with and live their lives alongside digital technologies. It is imperative to gain in-depth knowledge about the natural ways in which digital technologies are embedded in human everyday lives—for example, how people learn, interact and communicate in remote and hybrid settings or with artificial intelligence; how new digital technologies could be used to support continuous learning and understand learning processes better and how health and well-being can be promoted with the help of new digital solutions. Another significant consideration revolves around the co-creation of our digital futures. Important questions to be asked are as follows: Who are the ones to co-create digital solutions for the future? How can humans and human sciences better contribute to digitalisation and define how emerging technologies shape society and the future? Although academic and business actors have recently fostered inclusion and diversity in their co-creation processes, more must be done. The empowerment of ordinary people to start acting as active makers and shapers of our digital futures is required, as is giving voice to those who have traditionally been silenced or marginalised in the development of digital technology. In the emerging co-creation processes, emphasis should be placed on social sustainability and contextual sensitivity. Such processes are always value-laden and political and intimately intertwined with ethical issues. Constant and accelerating change characterises contemporary human systems, our everyday lives and the environment. Resilience thinking has become one of the major conceptual tools for understanding and dealing with change. It is a multi-scalar idea referring to the capacity of individuals and human systems to absorb disturbances and reorganise their functionality while undergoing a change. Based on the evolving new digital technologies, there is a pressing need to understand how these technologies could be utilised for human well-being, sustainable lifestyles and a better environment. This calls for analysing different scales and types of resilience in order to develop better technology-based solutions for human-centred development in the new digital era. This white paper is a collaborative effort by researchers from six faculties and groups working on questions related to digitalisation at the University of Oulu, Finland. We have identified questions and challenges related to the emerging digital era and suggest directions that will make possible a human-centric digital future and strengthen the competences of humans and humanity in this era.

Executive summary We are witnessing an emerging digital revolution. For the past 25–30 years, at an increasing pace, digital technologies—especially the internet, mobile phones and smartphones—have transformed the everyday lives of human beings. The pace of change will increase, and new digital technologies will become even more tightly entangled in human everyday lives. Artificial intelligence (AI), the Internet of Things (IoT), 6G wireless solutions, virtual reality (VR), augmented reality (AR), mixed reality (XR), robots and various platforms for remote and hybrid communication will become embedded in our lives at home, work and school. Digitalisation has been identified as a megatrend, for example, by the OECD (2016; 2019). While digitalisation processes permeate all aspects of life, special attention has been paid to its impact on the ageing population, everyday communication practices, education and learning and working life. For example, it has been argued that digital solutions and technologies have the potential to improve quality of life, speed up processes and increase efficiency. At the same time, digitalisation is likely to bring with it unexpected trends and challenges. For example, AI and robots will doubtlessly speed up or take over many routine-based work tasks from humans, leading to the disappearance of certain occupations and the need for re-education. This, in turn, will lead to an increased demand for skills that are unique to humans and that technologies are not able to master. Thus, developing human competences in the emerging digital era will require not only the mastering of new technical skills, but also the advancement of interpersonal, emotional, literacy and problem-solving skills. It is important to identify and describe the digitalisation phenomena—pertaining to individuals and societies—and seek human-centric answers and solutions that advance the benefits of and mitigate the possible adverse effects of digitalisation (e.g. inequality, divisions, vulnerability and unemployment). This requires directing the focus on strengthening the human skills and competences that will be needed for a sustainable digital future. Digital technologies should be seen as possibilities, not as necessities. There is a need to call attention to the co-evolutionary processes between humans and emerging digital technologies—that is, the ways in which humans grow up with and live their lives alongside digital technologies. It is imperative to gain in-depth knowledge about the natural ways in which digital technologies are embedded in human everyday lives—for example, how people learn, interact and communicate in remote and hybrid settings or with artificial intelligence; how new digital technologies could be used to support continuous learning and understand learning processes better and how health and well-being can be promoted with the help of new digital solutions. Another significant consideration revolves around the co-creation of our digital futures. Important questions to be asked are as follows: Who are the ones to co-create digital solutions for the future? How can humans and human sciences better contribute to digitalisation and define how emerging technologies shape society and the future? Although academic and business actors have recently fostered inclusion and diversity in their co-creation processes, more must be done. The empowerment of ordinary people to start acting as active makers and shapers of our digital futures is required, as is giving voice to those who have traditionally been silenced or marginalised in the development of digital technology. In the emerging co-creation processes, emphasis should be placed on social sustainability and contextual sensitivity. Such processes are always value-laden and political and intimately intertwined with ethical issues. Constant and accelerating change characterises contemporary human systems, our everyday lives and the environment. Resilience thinking has become one of the major conceptual tools for understanding and dealing with change. It is a multi-scalar idea referring to the capacity of individuals and human systems to absorb disturbances and reorganise their functionality while undergoing a change. Based on the evolving new digital technologies, there is a pressing need to understand how these technologies could be utilised for human well-being, sustainable lifestyles and a better environment. This calls for analysing different scales and types of resilience in order to develop better technology-based solutions for human-centred development in the new digital era. This white paper is a collaborative effort by researchers from six faculties and groups working on questions related to digitalisation at the University of Oulu, Finland. We have identified questions and challenges related to the emerging digital era and suggest directions that will make possible a human-centric digital future and strengthen the competences of humans and humanity in this era.

Introduction: Worldwide, health and social care systems struggle to develop processes that deliver coordinated, high quality care efficiently and at acceptable cost. For various reasons, many problems related to health and social care are extremely complex, including the fact that they involve many actors from different organizational levels. Such problems are sometimes described as "wicked" because of their complexity and the difficulties encountered when trying to solve them. One such problem is the increased demand on health and social care systems resulting from the ageing of populations. Given that health and social care systems are complex and adaptive, it is extremely challenging to make system-wide improvements. Large-scale change initiatives, such as comprehensive policies, have been proposed to address "wicked problems" in health and social care systems. However, such initiatives are difficult to implement because they require coordinated efforts over a long period of time. In recent years, Sweden has introduced several non-coercive, comprehensive policies aimed at managing fundamental concerns in health and social care. This thesis focuses on one such policy – the "Agreement on Coordinated Care for the Most Ill Elderly People". This policy derived from an agreement between the Swedish national government and the Swedish Association of Local Authorities and Regions (SALAR). The policy was implemented with national support in the years 2010 to 2014. Its aim was to help prepare the health and social care system to meet the demand for coordinated care for the increasing number of elderly people in Sweden. Aim: This thesis explores the implementation of a comprehensive policy that addresses a "wicked problem" in health and social care. Methods: This thesis takes a longitudinal case study approach. The four studies of the thesis focus on various actors' perspectives on, and opinions of, the policy. The actors work with health and social care on national, regional, and local levels. Theoretical approaches from different fields of research inform the research. Qualitative data were collected using individual interviews and focus groups, observations, and documents. Quantitative data were collected from national quality registries. Qualitative content analysis and descriptive statistics were used to analyse the data. Study I is a holistic multiple-case study that compares the policy process of two national health policies aimed at improving care and preventing disease. The study takes a policymaker perspective. A conceptual model of the policy process, based on two existing frameworks, is used to identify and analyse similarities and differences between the two policies. Study II is a holistic, single-case study that examines the activities and strategies the program management team at SALAR used to coordinate the implementation of the policy on a national basis. Study III is an embedded single-case study that investigates key county-level actors' perspectives on the implementation of the policy. The actors in the study are employed in three Swedish counties. Study IV is an embedded single-case study that investigates local actors' perspectives on the development of quality improvement work in elderly care with the support of the national policy. The actors in the study are employed in three Swedish municipalities. Findings: Study I shows that the current policy, in comparison with another policy with similar scope and aim, reveals more pragmatic view of evidence, a stronger emphasis on contextualization of evidence, more active and adaptive national-level implementation support, and an adaptive formulation of the policy involving annual renegotiations based on progress evaluations. Study II shows that the national implementation support was dynamic and emergent, and that the policy and the implementation process matched known drivers of effective, large-scale change. Study III shows that local conditions have a great influence on policy perception and that a significant variation exists among the counties. However, the results also show that external pressures (e.g., performance bonuses) strongly influence the counties' decision to participate in the policy implementation. Study IV shows that local conditions largely shape the municipal actors' perception of the policy. The county-level improvement coaches, who were very important for the policy implementation at the municipal level, were also important in facilitating learning and networking among the municipalities. The results also show that leadership engagement and the municipalities' ability to actively seek and use relevant external information are important factors in policy implementation. Conclusions: The policy was an ambitious attempt to implement a large-scale improvement initiative addressing a wicked problem in a complex adaptive system using a whole-systems approach. The findings suggest that when implementing such policies, policymakers should focus on involving relevant stakeholders and allow for the problem definition and the solutions to develop simultaneously because they are interdependent. Other issues to consider involve how the policy is communicated from national level and how a balance between steering and self-governance can be achieved. In addition, the results imply that networked support functions at the regional level can enhance the effect of national efforts to spread and implement comprehensive policies, and can also support the local capacity for knowledge development and quality improvement.

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA-disseminated and implemented in over 70 countries globally-is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease. ; European Innovation Partnership ; Montpellier Univ Hosp, Montpellier, France ; European Innovat Partnership Act & Hlth Ageing Re, MAlad Chron Vleillissement Actif France, MACVIA France, Montpellier, France ; INSERM, Ageing & Chron Dis Epidemiol & Publ Hlth Approach, U1168, F-94800 Villejuif, France ; Katholieke Univ Leuven, Dept Microbiol & Immunol, Clin Immunol Lab, Louvain, Belgium ; Transylvania Univ Brasov, Brasov, Romania ; Ghent Univ Hosp, ENT Dept, Upper Airways Res Lab, Ghent, Belgium ; Charite, Dept Dermatol & Allergy, Allergy Ctr Charite, Berlin, Germany ; Global Allergy & Asthma European Network, Berlin, Germany ; iQ4U Consultants Ltd, London, England ; Odense Univ Hosp, Dept Dermatol, Odense, Denmark ; Odense Univ Hosp, Allergy Ctr, Odense, Denmark ; Univ Sydney & Sydney Local Hlth Dist, Woolcock Inst Med Res, Glebe, NSW, Australia ; Hosp City Hlth & Sci Torino, Univ Pneumol Unit AOU Molinette, Turin, Italy ; Montpellier Univ Hosp, Dept Resp Dis, Montpellier, France ; Univ Fed Minas Gerais, Dept Pediat, Sch Med, Belo Horizonte, MG, Brazil ; Humanitas Univ, Asthma & Allergy Clin, Milan, Italy ; Univ S Florida, Div Allergy Immunol, Tampa, FL USA ; Leiden Univ, Med Ctr, Dept Publ Hlth & Primary Care, Leiden, Netherlands ; Univ Fed Bahia, ProAR Nucleo Excelencia Asma, Salvador, BA, Brazil ; GARD Execut Comm, Salvador, BA, Brazil ; EFA European Federat Allergy & Airways Dis Patien, Brussels, Belgium ; INSERM, EPAR U707, Paris, France ; Univ Paris 06, EPAR UMR S UPMC, Paris, France ; Suresnes Univ Versailles, Hop Foch, Lab Pharmacol Resp UPRES EA220, St Quentin en Yvelines, France ; Univ Porto, Ctr Res Hlth Technol & Informat Syst CINTESIS, Oporto, Portugal ; Inst CUF Porto, Allergy Unit, Oporto, Portugal ; Hosp CUF Porto, Oporto, Portugal ; Univ Porto, Fac Med, Hlth Informat & Decis Sci Dept CIDES, Rua Dr Placido da Costa S-N, P-4200450 Oporto, Portugal ; Acad Med Ctr, Dept Otorhinolaryngol, Amsterdam, Netherlands ; Erasmus Univ, Inst Hlth Policy & Management IBMG, Rotterdam, Netherlands ; Helsinki Univ Hosp, Skin & Allergy Hosp, Helsinki, Finland ; Univ Naples Federico II, Hosp Naples R&D & DISMET, Naples, Italy ; Univ Paris 06, UPMC,Equipe EPAR, Sorbonne Univ,Dept Allergol,Inst Pierre Louis Epi, Hopital Enfants Armand Trousseau,AP HP,Ctr Asthme, F-75013 Paris, France ; Charite, Inst Social Med Epidemiol & Hlth Econ, Berlin, Germany ; Univ Wurzburg, Inst Clin Epidemiol & Biometry, Wurzburg, Germany ; Ctr Rhinol & Allergol, Wiesbaden, Germany ; Med Univ Lodz, Barlicki Univ Hosp, Div Internal Med Asthma & Allergy, Lodz, Poland ; Univ Barcelona, CIBERES, IDIBAPS, Hosp Clin,ENT Dept,Clin & Expt Resp Immunoallergy, M Barcelona, Catalonia, Spain ; Univ Chicago, Med Ctr, Sect Otolaryngol Head & Neck Surg, Chicago, IL 60637 USA ; Univ Chicago, Pritzker Sch Med, Chicago, IL 60637 USA ; Monash Univ, Alfred Hosp, Dept Allergy Immunol & Resp Med, Melbourne, Vic, Australia ; Monash Univ, Cent Clin Sch, Melbourne, Vic, Australia ; Monash Univ, Dept Immunol, Melbourne, Vic, Australia ; Univ Manchester, Royal Manchester Childrens Hosp, Inst Human Dev, Ctr Pediat & Child Hlth, Manchester, Lancs, England ; Univ Athens, Athens Gen Childrens Hosp P&A Kyriakou, Pediat Clin 2, Dept Allergy, Athens, Greece ; Nippon Med Sch, Dept Pediat, Tokyo, Japan ; Univ Cape Town, Lung Inst, Allergy Diagnost & Clin Res Unit, Cape Town, South Africa ; Woodbrook Med Ctr, Loughborough, Leics, England ; Univ Edinburgh, Allergy & Resp Res Grp, Edinburgh, Midlothian, Scotland ; Med Univ Warsaw, Dept Prevent Environm Hazards & Allergol, Warsaw, Poland ; McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada ; Univ Edinburgh, Sch Med, Ctr Populat Hlth Sci, Allergy & Resp Res Grp, Edinburgh, Midlothian, Scotland ; Univ Manitoba, Fac Med, Dept Immunol, Dept Pediat & Child Hlth, Winnipeg, MB, Canada ; Univ Salerno, Div Allergy & Clin Immunol, Salerno, Italy ; Univ Coimbra, Fac Med, Ctr Pneumol, Coimbra, Portugal ; Med Univ Graz, Dept ENT, Graz, Austria ; Vilnius Univ, Fac Med, Clin Childrens Dis, Vilnius, Lithuania ; Vilnius Univ, Inst Publ Hlth, Vilnius, Lithuania ; European Acad Paediat EAP UEMS SP, Brussels, Belgium ; Univ Turku, Dept Lung Dis & Clin Allergol, Turku, Finland ; Terveystalo, Allergy Clin, Turku, Finland ; Univ Bari, Sch Med, Unit Geriatr Immunoallergol, Bari, Italy ; Soder Sjukhuset, Sachs Children & Youth Hosp, Stockholm, Sweden ; Karolinska Inst, Inst Environm Med, Stockholm, Sweden ; Queens Univ, Belfast, Antrim, North Ireland ; Celal Bayar Univ, Dept Pulmonol, Manisa, Turkey ; Med Univ Graz, Dept Dermatol, Graz, Austria ; Univ Zurich, Swiss Inst Allergy & Asthma Res SIAF, Davos, Switzerland ; Hosp Quiron Bizkaia, Dept Allergy & Immunol, Erandio, Spain ; Barcelona Inst Global Hlth ISGlobal, Barcelona, Spain ; IMIM Hosp Mar Res Inst, Barcelona, Spain ; CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain ; Univ Pompeu Fabra, Barcelona, Spain ; Kyomed, Montpellier, France ; Karolinska Inst, Dept Med Solna, Clin Immunol & Allergy Unit, Stockholm, Sweden ; Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Dept Pediat Pulmonol & Allergy, Stockholm, Sweden ; David Hide Asthma & Allergy Res Ctr, Isle Of Wight, England ; Reg Puglia, Bari, Italy ; Portuguese Natl Programme Resp Dis PNDR, Fac Med Lisbon, Lisbon, Portugal ; Univ Palermo, Dept Internal Med DIBIMIS, Geriatr Unit, Palermo, Italy ; Univ Cape Town, Dept Med, Cape Town, South Africa ; Univ Modena & Reggio Emilia, Dept Oncol Haematol & Resp Dis, Sect Resp Dis, Modena, Italy ; Univ Amsterdam, Acad Med Ctr, Dept Resp Med, Amsterdam, Netherlands ; Natl Inst Dis Chest & Hosp, Dept Resp Med, Dhaka, Bangladesh ; Linkoping Univ, Fac Med, Dept Pediat, Ctr Individualized Med, S-58185 Linkoping, Sweden ; Univ Bonn, Dept Dermatol & Allergy, Bonn, Germany ; Univ Hosp, Dept Resp Med & Allergol, Lund, Sweden ; Montpellier Univ Hosp, Dept Geriatr, BLAIN Montpellier, France ; Univ Montpellier, Euromov, EA 2991, Montpellier, France ; Univ Milan, IRCCS Fdn CaGranda Osped Maggiore Policlin, Dept Pathophysiol & Transplantat, Milan, Italy ; Univ Verona Hosp, Dept Pediat, Verona, Italy ; Univ Roma La Sapienza, Dept Publ Hlth & Infect Dis, Rome, Italy ; Univ Naples 2, Naples, Italy ; Italian Natl Res Council, Inst Translat Med, Naples, Italy ; Univ Laval, Quebec Heart & Lung Inst, Quebec City, PQ, Canada ; Univ Glasgow, Inst Hlth & Wellbeing, Hlth Econ & Hlth Technol Assessment, Glasgow, Lanark, Scotland ; Univ Hosp Leicester NHS Trust, Inst Lung Hlth, Resp Biomed Unit, Leicester, Leics, England ; Univ Leicester, Dept Infect Immun & Inflammat, Leicester, Leics, England ; Johannes Gutenberg Univ Mainz, Univ Med, Mainz, Germany ; Univ Med & Farm Timisoara, Timisoara, Romania ; Univ London Imperial Coll Sci Technol & Med, Royal Brompton Hosp NHS, London, England ; Ctr Med Docente Trinidad, Caracas, Venezuela ; Univ London Imperial Coll Sci Technol & Med, Natl Heart & Lung Inst, London, England ; Reg Languedoc Roussillon, Montpellier, France ; Hosp Valle De Hebron, S Allergol S Med Interna, Barcelona, Spain ; CEDOC, Resp Res Grp, Nova Med Sch, Lisbon, Portugal ; Ctr Hosp Lisboa Cent, EPE, Serv Imunoalergol, Lisbon, Portugal ; Reg Minist Hlth Andalusia, Seville, Spain ; Oslo Univ Hosp, Dept Paediat, Oslo, Norway ; Univ Oslo, Oslo, Norway ; Allergy & Asthma Associates Southern Calif, Mission Viejo, CA USA ; Metropolitan Univ, Univ Simon Bolivar, Allergy & Immunol Lab, Barranquilla, Colombia ; SLaai Sociedad Latinoamer Allergia Asma & Immunol, Cartagena, Colombia ; Gerontopole Toulouse, F-31059 Toulouse, France ; Univ Crete, Fac Med, Dept Social Med, Iraklion, NE, Greece ; Univ CEU San Pablo, Sch Med, Madrid, Spain ; Grigol Robakidze Univ, David Tvildiani Med Univ, AIETI Med Sch, Chachava Clin, Tbilisi, Rep of Georgia ; Pulmonolory Res Inst FMBA, Moscow, Russia ; GARD Execut Comm, Moscow, Russia ; IRCCS Azienda Osped Univ San Martino, Dept Med, Genoa, Italy ; Univ Minho, Sch Hlth Sci, Res Inst ICVS, ICVS 3BsPT Govt Associate Lab,Life & Hlth Sci, Braga, Portugal ; Nova Southeastern Univ, Dept Med, Davie, FL USA ; Scottish Ctr Telehealth & Telecare, NHS 24, European Innovat Partnership Act & Hlth Ageing, Reference Site,EIP AHA, Glasgow, Lanark, Scotland ; Univ London Imperial Coll Sci Technol & Med, Dept Pediat, London, England ; Karolinska Inst, Inst Environm Med, Ctr Allergy Res, Stockholm, Sweden ; Tech Univ Munich, Dept Dermatol & Allergy, Munich, Germany ; Helmholtz Ctr Munich, ZAUM Ctr Allergy & Environm, Munich, Germany ; AQuAS, Barcelona, Spain ; European Reg & Local Hlth Assoc, EUREGHA, Brussels, Belgium ; Luliu Hatieganu Univ Med & Pharm, Allergol & Immunol Discipline, Cluj Napoca, Romania ; McMaster Univ, Dept Med, Div Clin Immunol & Allergy, Hamilton, ON, Canada ; Peercode DV, Amsterdam, Netherlands ; Rangueil Larrey Hosp, Dept Resp Dis, Toulouse, France ; Univ Paris 05, Hop Cochin, AP HP, Serv Physiol Resp, Paris, France ; Ss Cyril & Methodius Univ, Fac Med, Univ Clin Pulmol & Allergy, Skopje, Macedonia ; Ctr Hosp Univ Beni Messous, Serv Pneumoallergol, Algiers, Algeria ; Ecole Mines, Ales, France ; Vilnius Univ, Fac Med, Vilnius, Lithuania ; Univ London Imperial Coll Sci Technol & Med, Natl Heart & Lung Inst, Allergy & Clin Immunol Sect, London, England ; Kings Coll London, Guys & St Thomas NHS Trust, London, England ; St Louis Univ, Sch Med, Sect Allergy & Immunol, St Louis, MO USA ; Umea Univ, Dept Comp Sci, Umea, Sweden ; Four Comp Oy, Halikko, Finland ; Ain Shams Univ, Pediat Allergy & Immunol Unit, Cairo, Egypt ; Social Serv & Publ Safety, Dept Hlth, Belfast, Antrim, North Ireland ; Global Allergy & Asthma Platform, Altgasse 8-10, A-1130 Vienna, Austria ; Bambino Gesu Childrens Res Hosp Holy See, Dept Pediat Med, Div Allergy, Rome, Italy ; Educ Hlth, Warwick, England ; Reg Hlth Serv Lazio Reg, Dept Epidemiol, Rome, Italy ; Athens Chest Hosp, Athens, Greece ; Natl Ctr Dis Control & Publ Hlth Georgia, Tbilisi, Rep of Georgia ; Istanbul Univ, Cerrahpasa Fac Med, Dept Pulm Dis, Istanbul, Turkey ; Clin Ricardo Palma, Allergy & Immunol Div, Lima, Peru ; Erasmus MC, Dept Internal Med, Sect Allergol, Rotterdam, Netherlands ; Univ Autonoma Nuevo Leon, San Nicolas De Los Garza, Mexico ; Latvian Assoc Allergists, Ctr TB & Lung Dis, Riga, Latvia ; Univ Washington, Sch Med, Dept Neurol, Seattle, WA 98195 USA ; Univ Hosp Olomouc, Natl eHlth Ctr, Olomouc, Czech Republic ; Univ Chile, Clin Hosp, Immunol & Allergy Div, Santiago, Chile ; Odense Univ Hosp, Dept Resp Dis, Odense, Denmark ; German Res Ctr Environm Hlth, Inst Epidemiol 1, Helmholtz Zentrum Munchen, Neuherberg, Germany ; Vienna Challenge Chamber, Vienna, Austria ; Univ Coll Cork, Dept Paediat & Child Hlth, Cork, Ireland ; Univ Paris 11, Le Kremlin Bicetre, France ; Hop Bicetre, Serv Pneumol, Le Kremlin Bicetre, France ; INSERM, UMR S999, Le Kremlin Bicetre, France ; Univ Plymouth, Sch Psychol, Plymouth, Devon, England ; Univ Salerno, Dept Med & Surg, Baronissi, Italy ; Libra Fdn, Buenos Aires, DF, Argentina ; Univ London Imperial Coll Sci Technol & Med, Natl Heart & Lung Inst, Airway Dis Infect Sect, London, England ; MRC & Asthma UK Ctr Allerg Mech Asthma, London, England ; Ghent Univ Hosp, Dept Resp Med, Ghent, Belgium ; Montpellier Univ Hosp, Med Commiss, Montpellier, France ; Hallym Univ, Coll Med, Hallym Univ Sacred Heart Hosp, Anyang, Gyeonggi Do, South Korea ; Wroclaw Med Univ, Dept Clin Immunol, Wroclaw, Poland ; Ukrainian Med Stomatol Acad, Poltava, Ukraine ; Fed Medicobiol Agcy, Inst Immunol, Natl Res Ctr, Lab Mol Immunol, Moscow, Russia ; Hacettepe Univ, Sch Med, Pediat Allergy & Asthma Unit, Ankara, Turkey ; Hacettepe Univ, Sch Med, Dept Chest Dis, Immunol & Allergy Div, Ankara, Turkey ; Med Univ Lodz, Dept Family Med 1, Lodz, Poland ; McMaster Univ, Dept Med, Hlth Sci Ctr 3V47, 1280 Main St W, Hamilton, ON, Canada ; Univ Groningen, Univ Med Ctr Groningen, Dept Pulm Dis, Groningen, Netherlands ; GARD, Geneva, Switzerland ; Univ Hosp Olomouc, Fac Med & Dent, Dept Resp Med, Olomouc, Czech Republic ; Univ Groningen, Univ Med Ctr Groningen, GRIAC Res Inst, Beatrix Childrens Hosp,Dept Pediat Pulmonol & Ped, Groningen, Netherlands ; Med Univ Lodz, Deptment Immunol Rheumatol & Allergy & HARC, Lodz, Poland ; Univ Helsinki, Childrens Hosp, Helsinki, Finland ; Vilnius Univ, Clin Infect Chest Dis Dermatol & Allergol, Vilnius, Lithuania ; Univ Ghent, VIB Inflammat Res Ctr, Ghent, Belgium ; Charite, Dept Pediat Pneumol & Immunol, Berlin, Germany ; Univ Med & Pharm, Hochiminh City, Vietnam ; Univ Tennessee, Coll Med, Dept Internal Med & Pediat, Div Allergy & Immunol, Germantown, TN USA ; Univ Dundee, Ninewells Hosp, Med Res Inst, Scottish Ctr Resp Res Cardiovasc & Diabet Med, Dundee, Scotland ; Guangzhou Med Univ, Affiliated Hosp 1, Guangzhou Inst Resp Dis, State Key Lab Resp Dis, Guangzhou, Guangdong, Peoples R China ; Univ Oslo, Fac Med, Inst Clin Med, Oslo, Norway ; CHU Sart Tilman, Dept Pulm Med, Liege, Belgium ; Med Univ Vienna, Ctr Pathophysiol Infectiol & Immunol, Dept Pathophysiol & Allergy Res, Div Immunopathol, Vienna, Austria ; Univ Edinburgh, Queens Med Res Inst, Edinburgh, Midlothian, Scotland ; Hop St Joseph, Serv Pneumoallergol, Paris, France ; Univ Nantes, UMR INSERM, Serv Pneumol, UMR1087, Nantes, France ; Univ Nantes, Inst Thorax, CNR 6291, Nantes, France ; Rashid Hosp, Dept Pulm Med, Dubai, U Arab Emirates ; Biomax Informat AG, Munich, Germany ; Univ Bratislava, Dept Resp Med, Bratislava, Slovakia ; Univ Coimbra, Fac Med, Inst Biomed Imaging & Life Sci, Coimbra, Portugal ; Ageing@Coimbra EIP AHA Reference Site, Coimbra, Portugal ; Bon Secours Hosp, Dept Med, Dublin, Ireland ; Kronikgune, Basque Region, Spain ; Univ Mississippi, Med Ctr, Div Clin Immunol & Allergy, Lab Behav Immunol Res, Jackson, MS USA ; Iranian Anti Tobacco Assoc, Tobacco Control Res Ctr, Tehran, Iran ; Maputo Cent Hosp, Dept Paediat, Maputo, Mozambique ; Allergy & Asthma Med Grp & Res Ctr, San Diego, CA USA ; Univ Montpellier, Dept Physiol, CHRU, PhyMedExp,INSERM U1046,CNRS UMR 9214, Montpellier, France ; Rhein Westfal TH Aachen, Univ Klinikum, Hautklin Klin Dermatol & Allergol, Aachen, Germany ; Croatian Pulm Soc, Zagreb, Croatia ; Natl Inst Pneumol M Nasta, Bucharest, Romania ; Univ Belgrade, Fac Med, Belgrade, Serbia ; Serbian Assoc Asthma & COPD, Belgrade, Serbia ; Caisse Assurance Retraite & Sante Travail Langued, Montpellier, France ; Tishreen Univ, Sch Med, Natl Ctr Res Chron Resp Dis, Latakia, Syria ; Paris Descartes Univ, Sorbonne Paris Cite, Dept Publ Hlth & Hlth Prod, EA 4064, Paris, France ; Paris Municipal Dept Social Act Childhood & Hlth, Paris, France ; Univ Cologne, Fac Med, Inst Med Stat Informat & Epidemiol, Cologne, Germany ; Padua Gen Univ Hosp, Dept Women & Child Hlth, Food Allergy Referral Ctr Veneto Reg, Padua, Italy ; Russian Acad Med Sci, Sci Ctr Childrens Hlth, Moscow, Russia ; Hosp Ninos Orlando Alassia, Santa Fe, Argentina ; Hosp Hosp Bros Buda, Budapest, Hungary ; Hosp La Fe, Neumol & Alergol Infantil, Valencia, Spain ; Ctr Hosp Sao Joao, Dept Internal Med, Oporto, Portugal ; Univ Hosp Kinshasa, ENT Dept, Kinshasa, DEM REP CONGO ; Tokyo Natl Hosp, Natl Hosp Org, Tokyo, Japan ; Chiba Univ Hosp, Dept Otorhinolaryngol, Chiba, Japan ; Nippon Med Sch, Dept Otolaryngol, Tokyo, Japan ; Ctr Hosp Univ Pediatr Charles Gaulle, Ouagadougou, Burkina Faso ; Univ Hosp Pisa, Cardiothorac & Vasc Dept, Pisa, Italy ; Med Univ, Univ Vet Med, Messerli Res Inst, Dept Comparat Med, Vienna, Austria ; Charles Univ Prague, Fac Med, Dept Immunol & Allergol, Plzen, Czech Republic ; Charles Univ Prague, Fac Hosp Pilsen, Plzen, Czech Republic ; Univ Ferrara, Dept Med Sci, Resp Med, Ferrara, Italy ; Ajou Univ, Sch Med, Dept Allergy & Clin Immunol, Suwon, South Korea ; Univ Southern Denmark, Kolding, Denmark ; CUF Porto Hosp & Inst, Allergy Unit, Oporto, Portugal ; Heidelberg Univ, Med Fac Mannheim, Univ Med Mannheim, Dept Otorhinolaryngol Head & Neck Surg, Mannheim, Germany ; Minist Econ Ind & Numer, Conseil Gen Econ, Paris, France ; Espace Francophone Pneumol, Soc Pneumol Langue Francaise, Paris, France ; CHU Grenoble, Dept Pediat, Grenoble, France ; Childrens Hosp Srebrnjak, Zagreb, Croatia ; Univ JJ Strossmayer, Sch Med, Osijek, Croatia ; Hietzing Hosp, Karl Landsteiner Inst Clin & Expt Pneumol, Vienna, Austria ; Med Univ Sofia, Clin Allergy & Asthma, Sofia, Bulgaria ; Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands ; Copenhagen Univ Hosp Gentofte, Allergy Clin, Lab Med Allergol, Copenhagen, Denmark ; Univ Aberdeen, Acad Ctr Primary Care, Aberdeen, Scotland ; Res Real Life, Cambridge, England ; German Ctr Lung Res DZL, Airway Res Ctr North, LungenClin Grosshansdorf, Grosshansdorf, Germany ; Univ Kiel, German Ctr Lung Res DZL, Airway Res Ctr North, Dept Med, Kiel, Germany ; Southampton Univ Hosp, NHS Fdn Trust, Southampton, Hants, England ; Coimbra Univ Hosp, Ctr Pneumol, Coimbra, Portugal ; Univ Valencia, Polibienestar Res Inst, Valencia, Spain ; Getafe Univ Hosp, Dept Geriatr, Madrid, Spain ; Assoc Asthme & Allergie, Paris, France ; Inst Invest Sanitaria Palma IdisPa, Primary Care Resp Res Unit, Palma De Mallorca, Spain ; Complesso Integrato Columbus, Allergy Unit, Rome, Italy ; Hosp Luz, Serv Imunoalergol, Lisbon, Portugal ; Univ Parana, Hosp Clin, Curitiba, Parana, Brazil ; Emek Med Ctr, Div Allergy Asthma & Clin Immunol, Afula, Israel ; Ctr Med Docente Trinidad & Clin El Avila, Allergy & Clin Immunol Dept, Caracas, Venezuela ; Autononous Univ Madrid, Fac Med, Madrid, Spain ; UCL, Royal Natl TNE Hosp, London, England ; Univ Palermo, DIBIMIS, Palermo, Italy ; Univ Zurich Hosp, Dept Dermatol, Allergy Unit, Zurich, Switzerland ; CHU Rangueil Larrey, Otolaryngol & Head & Neck Surg, Toulouse, France ; Queens Univ, Child Hlth, Belfast, Antrim, North Ireland ; Royal Belfast Hosp Sick Children, Belfast, Antrim, North Ireland ; Univ Joseph Fourier, Team Environm Epidemiol Appl Reprod & Resp Hlth, Univ Grenoble Alpes, INSERM,IAB U 1209, Grenoble, France ; Soc Paraguaya Alergia Asma & Inmunol, Asuncion, Paraguay ; Univ Utrecht, Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands ; Univ Fed Sao Paulo, Dept Pediat, Div Allergy Clin Immunol & Rheumatol, Sao Paulo, Brazil ; Euro Asian Resp Soc, Kyrgyzstan Natl Ctr Cardiol & Internal Med, Bishkek, Kyrgyzstan ; Univ Sao Paulo, Fac Med, Hosp Clin, Div Pulm,Inst Heart InCor, Sao Paulo, Brazil ; Univ Amsterdam, Acad Med Ctr, Amsterdam, Netherlands ; European Union Geriatr Med Soc EUGMS, Helsinki, Finland ; Maastricht Univ, CAPHRI Sch Publ Hlth & Primary Care, Dept Epidemiol, Maastricht, Netherlands ; IDIBAPS, Hosp Clin, Pneumol & Allergy Dept, Clin & Expt Resp Immunoallergy, Barcelona, Spain ; PELyon, Lyon, France ; Univ Claude Bernard Lyon, Hlth Serv & Performance Res, HESPER 7425, Villeurbanne, France ; Univ Hosp, Stockholm, Sweden ; Catholic Univ Louvain, Univ UCL Namur, Ctr Hosp Univ UCL Namur, Dept Chest Med, Yvoir, Belgium ; Philippines Soc Allergy Asthma & Immunol, Manila, Philippines ; Res Hosp, Arcispedale S Maria Nuova IRCCS, Dept Cardiol Thorac & Vasc Med, Pulm Unit, Reggio Emilia, Italy ; Reg Agcy Hlth & Social Care, Reggio Emilia, Italy ; Finnish Lung Assoc FILHA, Helsinki, Finland ; CNR Inst Clin Physiol, Pulm Environm Epidemiol Unit, Pisa, Italy ; CNR, Inst Biomed & Mol Immunol A Monroy, Palermo, Italy ; Sotiria Hosp, Athens, Greece ; Univ Klinikum Dusseldorf, HNO Klin, Dept Otorhinolaryngol, Dusseldorf, Germany ; Asthma UK, Mansell St, London, England ; Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Otolaryngol, Singapore, Singapore ; Hannover Med Sch, Dept Dermatol & Allergy, Div Immunodermatol & Allergy Res, Hannover, Germany ; Univ N Carolina, Eshelman Sch Pharm, Chapel Hill, NC USA ; IPCRG, Aberdeen, Scotland ; Bradford Royal Infirm, Bradford Inst Hlth Res, Bradford, W Yorkshire, England ; Olmsted Med Ctr, Dept Res, Rochester, MN USA ; Univ Cyprus, Sch Med, Nicosia, Cyprus ; Allergy & Asthma Inst, Lahore, Pakistan ; Univ Southampton, Social Sci, Southampton, Hants, England ; Univ Cape Town, Red Cross Childrens Hosp, Dept Paediat & Child Hlth, Cape Town, South Africa ; Univ Cape Town, MRC Unit Child & Adolescent Hlth, Cape Town, South Africa ; Univ Catolica Cordoba, Cordoba, Argentina ; Beijing TongRen Hosp, Dept Otolaryngol Head & Neck Surg, Beijing, Peoples R China ; Beijing Inst Otolaryngol, Beijing, Peoples R China ; Univ Clin Resp & Allerg Dis, Golnik, Slovenia ; Northern Hlth Alliance, Newcastle Upon Tyne, Tyne & Wear, England ; CHRU Arnaud Villeneuve, 371 Ave Doyen Gaston Giraud, Montpellier 5, France ; Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil ; Web of Science

Physical activity (PA) may modify the genetic effects that give rise to increased risk of obesity. To identify adiposity loci whose effects are modified by PA, we performed genome-wide interaction meta-analyses of BMI and BMI-adjusted waist circumference and waist-hip ratio from up to 200,452 adults of European (n = 180,423) or other ancestry (n = 20,029). We standardized PA by categorizing it into a dichotomous variable where, on average, 23% of participants were categorized as inactive and 77% as physically active. While we replicate the interaction with PA for the strongest known obesity-risk locus in the FTO gene, of which the effect is attenuated by ~30% in physically active individuals compared to inactive individuals, we do not identify additional loci that are sensitive to PA. In additional genome-wide meta-analyses adjusting for PA and interaction with PA, we identify 11 novel adiposity loci, suggesting that accounting for PA or other environmental factors that contribute to variation in adiposity may facilitate gene discovery. ; The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services. Funding for this study was provided by the Aase and Ejner Danielsens Foundation; Academy of Finland (102318; 104781, 120315, 123885, 129619, 286284, 134309, 126925, 121584, 124282, 129378, 117787, 250207, 258753, 41071, 77299, 124243, 1114194, 24300796); Accare Center for Child and Adolescent Psychiatry; Action on Hearing Loss (G51); Agence Nationale de la Recherche; Agency for Health Care Policy Research (HS06516); Age UK Research into Ageing Fund; Åke Wiberg Foundation; ALF/LUA Research Grant in Gothenburg; ALFEDIAM; ALK-Abello´ A/S (Hørsholm, Denmark); American Heart Association (13POST16500011, 10SDG269004); Ardix Medical; Arthritis Research UK; Association Diabète Risque Vasculaire; AstraZeneca; Australian Associated Brewers; Australian National Health and Medical Research Council (241944, 339462, 389927, 389875, 389891, 389892, 389938, 442915, 442981, 496739, 552485, 552498); Avera Research Institute; Bayer Diagnostics; Becton Dickinson; Biobanking and Biomolecular Resources Research Infrastructure (BBMRI –NL, 184.021.007); Biocentrum Helsinki; Boston Obesity Nutrition Research Center (DK46200); British Heart Foundation (RG/10/12/28456, SP/04/002); Canada Foundation for Innovation; Canadian Institutes of Health Research (FRN-CCT-83028); Cancer Research UK; Cardionics; Center for Medical Systems Biology; Center of Excellence in Complex Disease Genetics and SALVECenter of Excellence in Genomics (EXCEGEN); Chief Scientist Office of the Scottish Government; City of Kuopio; Cohortes Santé TGIR; Contrat de Projets État-Région; Croatian Science Foundation (8875); Danish Agency for Science, Technology and Innovation; Danish Council for Independent Research (DFF–1333-00124, DFF–1331-007308); Danish Diabetes Academy; Danish Medical Research Council; Department of Psychology and Education of the VU University Amsterdam; Diabetes Hilfs- und Forschungsfonds Deutschland; Dutch Brain Foundation; Dutch Ministry of Justice; Emil Aaltonen Foundation; Erasmus Medical Center; Erasmus University; Estonian Government (IUT20-60, IUT24-6); Estonian Ministry of Education and Research (3.2.0304.11-0312); European Commission (230374, 284167, 323195, 692145, FP7 EurHEALTHAgeing-277849, FP7 BBMRI-LPC 313010, nr 602633, HEALTH-F2-2008-201865-GEFOS, HEALTH-F4-2007-201413, FP6 LSHM-CT-2004-005272, FP5 QLG2-CT-2002-01254, FP6 LSHG-CT-2006-01947, FP7 HEALTH-F4-2007-201413, FP7 279143, FP7 201668, FP7 305739, FP6 LSHG-CT-2006-018947, HEALTH-F4-2007-201413, QLG1-CT-2001-01252); European Regional Development Fund; European Science Foundation (EuroSTRESS project FP-006, ESF, EU/QLRT-2001-01254); Faculty of Biology and Medicine of Lausanne; Federal Ministry of Education and Research (01ZZ9603, 01ZZ0103, 01ZZ0403, 03ZIK012, 03IS2061A); Federal State of Mecklenburg - West Pomerania; Fédération Française de Cardiologie; Finnish Cultural Foundation; Finnish Diabetes Association; Finnish Foundation of Cardiovascular Research; Finnish Heart Association; Food Standards Agency; Fondation de France; Fonds Santé; Genetic Association Information Network of the Foundation for the National Institutes of Health; German Diabetes Association; German Federal Ministry of Education and Research (BMBF, 01ER1206, 01ER1507); German Research Council (SFB-1052, SPP 1629 TO 718/2-1); GlaxoSmithKline; Göran Gustafssons Foundation; Göteborg Medical Society; Health and Safety Executive; Heart Foundation of Northern Sweden; Icelandic Heart Association; Icelandic Parliament; Imperial College Healthcare NHS Trust; INSERM, Réseaux en Santé Publique, Interactions entre les déterminants de la santé; Interreg IV Oberrhein Program (A28); Italian Ministry of Economy and Finance; Italian Ministry of Health (ICS110.1/RF97.71); John D and Catherine T MacArthur Foundation; Juho Vainio Foundation; King's College London; Kjell och Märta Beijers Foundation; Kuopio University Hospital; Kuopio, Tampere and Turku University Hospital Medical Funds (X51001); Leiden University Medical Center; Lilly; LMUinnovativ; Lundbeck Foundation; Lundberg Foundation; Medical Research Council of Canada; MEKOS Laboratories (Denmark); Merck Santé; Mid-Atlantic Nutrition Obesity Research Center (P30 DK72488); Ministère de l'Économie, de l'Innovation et des Exportations; Ministry for Health, Welfare and Sports of the Netherlands; Ministry of Cultural Affairs of the Federal State of Mecklenburg-West Pomerania; Ministry of Education and Culture of Finland (627;2004-2011); Ministry of Education, Culture and Science of the Netherlands; MRC Human Genetics Unit; MRC-GlaxoSmithKline Pilot Programme Grant (G0701863); Municipality of Rotterdam; Netherlands Bioinformatics Centre (2008.024); Netherlands Consortium for Healthy Aging (050-060-810); Netherlands Genomics Initiative; Netherlands Organisation for Health Research and Development (904-61-090, 985-10-002, 904-61-193, 480-04-004, 400-05-717, Addiction-31160008, Middelgroot-911-09-032, Spinozapremie 56-464-14192); Netherlands Organisation for Health Research and Development (2010/31471/ZONMW); Netherlands Organisation for Scientific Research (10-000-1002, GB-MW 940-38-011, 100-001-004, 60-60600-97-118, 261-98-710, GB-MaGW 480-01-006, GB-MaGW 480-07-001, GB-MaGW 452-04-314, GB-MaGW 452-06-004, 175.010.2003.005, 175.010.2005.011, 481-08-013, 480-05-003, 911-03-012); Neuroscience Campus Amsterdam; NHS Foundation Trust; Novartis Pharmaceuticals; Novo Nordisk; Office National Interprofessionel des Vins; Paavo Nurmi Foundation; Påhlssons Foundation; Päivikki and Sakari Sohlberg Foundation; Pierre Fabre; Republic of Croatia Ministry of Science, Education and Sport (108-1080315-0302); Research Centre for Prevention and Health, the Capital Region for Denmark; Research Institute for Diseases in the Elderly (014-93-015, RIDE2); Roche; Russian Foundation for Basic Research (NWO-RFBR 047.017.043); Rutgers University Cell and DNA Repository (NIMH U24 MH068457-06); Sanofi-Aventis; Scottish Executive Health Department (CZD/16/6); Siemens Healthcare; Social Insurance Institution of Finland (4/26/2010); Social Ministry of the Federal State of Mecklenburg-West Pomerania; Société Francophone du Diabète; State of Bavaria; Stroke Association; Swedish Diabetes Association; Swedish Foundation for Strategic Research; Swedish Heart-Lung Foundation (20140543); Swedish Research Council (2015-03657); Swedish Medical Research Council (K2007-66X-20270-01-3, 2011-2354); Swedish Society for Medical Research; Swiss National Science Foundation (33CSCO-122661, 33CS30-139468, 33CS30-148401); Tampere Tuberculosis Foundation; The Marcus Borgström Foundation; The Royal Society; The Wellcome Trust (084723/Z/08/Z, 088869/B/09/Z); Timber Merchant Vilhelm Bangs Foundation; Topcon; Torsten and Ragnar Söderberg's Foundation; UK Department of Health; UK Diabetes Association; UK Medical Research Council (MC_U106179471, G0500539, G0600705, G0601966, G0700931, G1002319, K013351, MC_UU_12019/1); UK National Institute for Health Research BioResource Clinical Research Facility and Biomedical Research Centre; UK National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre; UK National Institute for Health Research (RP-PG-0407-10371); Umeå University Career Development Award; United States – Israel Binational Science Foundation Grant (2011036); University Hospital Oulu (75617); University Medical Center Groningen; University of Tartu (SP1GVARENG); National Institutes of Health (AG13196, CA047988, HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, HHSC271201100004C, HHSN268200900041C, HHSN268201300025C, HHSN268201300026C, HHSN268201300027C, HHSN268201300028C, HHSN268201300029C, HHSN268201500001I, HL36310, HG002651, HL034594, HL054457, HL054481, HL071981, HL084729, HL119443, HL126024, N01-AG12100, N01-AG12109, N01-HC25195, N01-HC55015, N01-HC55016, N01-HC55018, N01-HC55019, N01-HC55020, N01-HC55021, N01-HC55022, N01-HD95159, N01-HD95160, N01-HD95161, N01-HD95162, N01-HD95163, N01-HD95164, N01-HD95165, N01-HD95166, N01-HD95167, N01-HD95168, N01-HD95169, N01-HG65403, N02-HL64278, R01-HD057194, R01-HL087641, R01-HL59367, R01HL-086694, R01-HL088451, R24-HD050924, U01-HG-004402, HHSN268200625226C, UL1-RR025005, UL1-RR025005, UL1-TR-001079, UL1-TR-00040, AA07535, AA10248, AA11998, AA13320, AA13321, AA13326, AA14041, AA17688, DA12854, MH081802, MH66206, R01-D004215701A, R01-DK075787, R01-DK089256, R01-DK8925601, R01-HL088451, R01-HL117078, R01-DK062370, R01-DK072193, DK091718, DK100383, DK078616, 1Z01-HG000024, HL087660, HL100245, R01DK089256, 2T32HL007055-36, U01-HL072515-06, U01-HL84756, NIA-U01AG009740, RC2-AG036495, RC4-AG039029, R03 AG046389, 263-MA-410953, 263-MD-9164, 263-MD-821336, U01-HG004802, R37CA54281, R01CA63, P01CA33619, U01-CA136792, U01-CA98758, RC2-MH089951, MH085520, R01-D0042157-01A, MH081802, 1RC2-MH089951, 1RC2-MH089995, 1RL1MH08326801, U01-HG007376, 5R01-HL08767902, 5R01MH63706:02, HG004790, N01-WH22110, U01-HG007033, UM1CA182913, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, 44221); USDA National Institute of Food and Agriculture (2007-35205-17883); Västra Götaland Foundation; Velux Foundation; Veterans Affairs (1 IK2 BX001823); Vleugels Foundation; VU University's Institute for Health and Care Research (EMGO+, HEALTH-F4-2007-201413) and Neuroscience Campus Amsterdam; Wellcome Trust (090532, 091551, 098051, 098381); Wissenschaftsoffensive TMO; and Yrjö Jahnsson Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ; Peer Reviewed

Debarun Bhattacharjya (" Formulating Asymmetric Decision Problems as Decision Circuits " and " From Reliability Block Diagrams to Fault Tree Circuits ") is a research staff member in the Risk Analytics team within the broader Business Analytics and Math Sciences division at IBM T.J. Watson Research Center. He received his Ph.D. in management science and engineering at Stanford University. His primary research interests lie in decision and risk analysis, and probabilistic models and decision theory in artificial intelligence. Specifically, he has pursued research in probabilistic graphical models (influence diagrams and Bayesian networks), value of information, sensitivity analysis, and utility theory. His applied work has been in domains such as sales, energy, business services, and public policy. He has coauthored more than 10 publications in highly refereed journals and conference proceedings, as well as two patents. He was nominated by IBM management for the Young Researcher Connection at the Institute for Operations Research and the Management Sciences (INFORMS) Practice Conference in 2010. Email: debarunb@us.ibm.com . May Cheung (" Regulation Games Between Government and Competing Companies: Oil Spills and Other Disasters ") is an undergraduate senior in the Department of Industrial and Systems Engineering at the University at Buffalo. Her research interests are in decision analysis, optimization, and simulation with respect to complex, high-impact decisions. Email: mgcheung@buffalo.edu . Léa A. Deleris (" From Reliability Block Diagrams to Fault Tree Circuits ") is a research staff member and manager at IBM Dublin Research Laboratory, where she oversees the Risk Collaboratory, a three-year research project funded in part by the Irish Industrial Development Agency around risk management, from stochastic optimization to the communication of risk information to decision makers. Prior to joining the Dublin lab, she was a research staff member with the Risk Analytics Group, Business Application and Mathematical Science Department, IBM T.J. Watson Research Center, Yorktown Heights, New York. Her primary interests have been in the fields of decision theory and risk analysis. Her work is currently focused on leveraging natural language processing techniques to facilitate the construction of risk models, distributed elicitation of expert opinions, and value of information problems. She holds a Ph.D. in management science and engineering from Stanford University. Email: lea.deleris@ie.ibm.com . Philippe Delquié (" Risk Measures from Risk-Reducing Experiments ") is an associate professor of decision sciences at the George Washington University, and holds a Ph.D. from Massachusetts Institute of Technology. Professor Delquié's teaching and research are in decision, risk, and multicriteria analysis. His research is at the nexus of behavioral and normative theories of decision, addressing issues in preference elicitation, value of information, nonexpected utility models of choice, and risk measures. Prior to joining the George Washington University, he held academic appointments at INSEAD, the University of Texas at Austin, and École Normale Supérieure, France, and visiting appointments at Duke University's Fuqua School of Business. He is on the editorial board of Decision Analysis and has completed a term as an associate editor. Email: delquie@gwu.edu . Lorraine Dodd (" Regulating Autonomous Agents Facing Conflicting Objectives: A Command and Control Example ") is a highly respected international contributor to command and leadership studies within military and UK governmental command, control, intelligence and information analysis, and research. She has an honours degree in pure mathematics and an M.Sc. in operational research and management science from the University of Warwick majoring in catastrophe theory and nonlinearity. Her main interest is in sense-making, decision making, and risk taking under conditions of uncertainty, confusion, volatility, ambiguity, and contention, as applied to the study of institutions, organizations, society, people, and governance. She uses analogy with brain functions and coherent cellular functions to develop mathematical models of complex decision behavior. Her most recent studies include an application of a multiagency, multiperspective approaches to collaborative decision making and planning, and development of an "open-eyes/open-mind" framework to provide support to leaders when dealing with complex crises and "black swans." She has developed an understanding of the nonlinear, slow and fast dynamics of behavior, in particular, of means of organizing for agility in complex and uncertain environments. Email: l.dodd@cranfield.ac.uk . Rachele Foschi (" Interactions Between Ageing and Risk Properties in the Analysis of Burn-in Problems ") has an M.Sc. and a Ph.D. in mathematics from the University of Rome La Sapienza, where she also worked as a tutor for the courses of calculus and probability. Currently, she is an assistant professor in the Economics and Institutional Change Research Area at IMT (Institutions, Markets, Technologies) Advanced Studies, in Lucca, Italy. Her research interests include stochastic dependence, reliability, stochastic orders, point processes, and mathematical models in economics. Random sets and graphs, linguistics, and behavioral models are of broader interest to her. Email: rachele.foschi@imtlucca.it . Simon French (" Expert Judgment, Meta-analysis, and Participatory Risk Analysis ") recently joined the Department of Statistics at the University of Warwick to become the director of the Risk Initiative and Statistical Consultancy Unit. Prior to joining the University of Warwick, he was a professor of information and decision sciences at Manchester Business School. Simon's research career began in Bayesian statistics, and he was one of the first to apply hierarchical modeling, particularly in the domain of protein crystallography. Nowadays he is better known for his work on decision making, which began with his early work on decision theory. Over the years, his work has generally become more applied: looking at ways of supporting real decision makers facing major strategic and risk issues. In collaboration with psychologists, he has sought to support real decision makers and stakeholders in complex decisions in ways that are mindful of their human characteristics. He has a particular interest in societal decision making, particularly with respect to major risks. He has worked on public risk communication and engagement and the wider areas of stakeholder involvement and deliberative democracy. Simon has worked across the public and private sectors, often in contexts that relate to the environment, energy, food safety, and the nuclear industry. In all of his work, the emphasis is on multidisciplinary and participatory approaches to solving real problems. Email: simon.french@warwick.ac.uk . L. Robin Keller (" From the Editors: Games and Decisions in Reliability and Risk ") is a professor of operations and decision technologies in the Merage School of Business at the University of California, Irvine. She received her Ph.D. and M.B.A. in management science and her B.A. in mathematics from the University of California, Los Angeles. She has served as a program director for the Decision, Risk, and Management Science Program of the U.S. National Science Foundation (NSF). Her research is on decision analysis and risk analysis for business and policy decisions and has been funded by NSF and the U.S. Environmental Protection Agency. Her research interests cover multiple attribute decision making, riskiness, fairness, probability judgments, ambiguity of probabilities or outcomes, risk analysis (for terrorism, environmental, health, and safety risks), time preferences, problem structuring, cross-cultural decisions, and medical decision making. She is currently the editor-in-chief of Decision Analysis, published by the Institute for Operations Research and the Management Sciences (INFORMS). She is a fellow of INFORMS and has held numerous roles in INFORMS, including board member and chair of the INFORMS Decision Analysis Society. She is a recipient of the George F. Kimball Medal from INFORMS. She has served as the decision analyst on three National Academy of Sciences committees. Email: lrkeller@uci.edu . Miguel A. Lejeune (" Game Theoretical Approach for Reliable Enhanced Indexation ") is an assistant professor of decision sciences at the George Washington University (GWU) and holds a Ph.D. degree from Rutgers University. Prior to joining GWU, he was a visiting assistant professor in operations research at Carnegie Mellon University. His areas of expertise/research interests include stochastic programming, financial risk, and large-scale optimization. He is the recipient of a Young Investigator/CAREER Research Grant (2009) from the Army Research Office. He also received the IBM Smarter Planet Faculty Innovation Award (December 2011) and the Royal Belgian Sciences Academy Award for his master's thesis. Email: mlejeune@gwu.edu . Jason R. W. Merrick (" From the Editors: Games and Decisions in Reliability and Risk ") is a professor in the Department of Statistical Sciences and Operations Research at Virginia Commonwealth University. He has a D.Sc. in operations research from the George Washington University. He teaches courses in decision analysis, risk analysis, and simulation. His research is primarily in the area of decision analysis and Bayesian statistics. He has worked on projects ranging from assessing maritime oil transportation and ferry system safety, the environmental health of watersheds, and optimal replacement policies for rail tracks and machine tools, and he has received grants from the National Science Foundation, the Federal Aviation Administration, the United States Coast Guard, the American Bureau of Shipping, British Petroleum, and Booz Allen Hamilton, among others. He has also performed training for Infineon Technologies, Wyeth Pharmaceuticals, and Capital One Services. He is an associate editor for Decision Analysis and Operations Research. He is the information officer for the Decision Analysis Society of INFORMS. Email: jrmerric@vcu.edu . Gilberto Montibeller (" Modeling State-Dependent Priorities of Malicious Agents ") is a tenured lecturer in decision sciences in the Department of Management at the London School of Economics (LSE). With a first degree in electrical engineering (Universidade Federal de Santa Catarina (UFSC), Brazil, 1993), he started his career as an executive at British and American Tobacco. Moving back to academia, he was awarded a master's degree (UFSC, 1996) and a Ph.D. in production engineering (UFSC/University of Strathclyde, United Kingdom, 2000). He then continued his studies as a postdoctoral research fellow in management science at the University of Strathclyde (2002–2003). He is an area editor of the Journal of Multi-Criteria Decision Analysis, and he is on the editorial board of Decision Analysis and the EURO Journal on Decision Processes. His main research interest is on supporting strategic-level decision making, both in terms of decision analytic methodologies and of decision processes. He has been funded by the AXA Research Fund, United Kingdom's EPSRC (Engineering and Physical Sciences Research Council), and Brazil's CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior). His research has been published in journals such as the European Journal of Operational Research, Decision Support Systems, and OMEGA—The International Journal of Management Science. One of his papers, on the evaluation of strategic options and scenario planning, was awarded the Wiley Prize in Applied Decision Analysis by the International Society of Multi-Criteria Decision Making. He has had visiting positions at the International Institute for Applied Systems Analysis (IIASA, Austria) and the University of Warwick (United Kingdom), and is a visiting associate professor of production engineering at the University of São Paulo (Brazil). He also has extensive experience in applying decision analysis in practice; over the past 17 years he has provided consulting to both private and public organizations in Europe and South America. He is a regular speaker at the LSE Executive Education courses. Email: g.montibeller@lse.ac.uk . M. Elisabeth Paté-Cornell (" Games, Risks, and Analytics: Several Illustrative Cases Involving National Security and Management Situations ") specializes in engineering risk analysis with application to complex systems (space, medical, etc.). Her research has focused on explicit inclusion of human and organizational factors in the analysis of systems' failure risks. Her recent work is on the use of game theory in risk analysis with applications that have included counterterrorism and nuclear counterproliferation problems. She is a member of the National Academy of Engineering, the French Académie des Technologies, and of several boards, including Aerospace, Draper Laboratory, and In-Q-Tel. Dr. Paté-Cornell was a member of the President's Foreign Intelligence Advisory Board from December 2001 to 2008. She holds an engineering degree (applied mathematics and computer science) from the Institut Polytechnique de Grenoble (France), an M.S. in operations research and a Ph.D. in engineering-economic systems, both from Stanford University. Email: mep@stanford.edu . Jesus Rios (" Adversarial Risk Analysis: The Somali Pirates Case ") is a research staff member at the IBM T.J. Watson Research Center. He has a Ph.D. in computer sciences and mathematical modeling from the University Rey Juan Carlos. Before joining IBM, he worked in several universities as a researcher, including the University of Manchester, the University of Luxembourg, Aalborg University, and Concordia University. He participated in the 2007 SAMSI program on Risk Analysis, Extreme Events, and Decision Theory, and led work in the area of adversarial risk analysis. He has also worked as a consultant for clients in the transportation, distribution, energy, defense, and telecommunication sectors. His main research interests are in the areas of risk and decision analysis and its applications. Email: jriosal@us.ibm.com . David Rios Insua (" Adversarial Risk Analysis: The Somali Pirates Case ") is a professor of statistics and operations research at Rey Juan Carlos University and a member of the Spanish Royal Academy of Sciences. He has written 15 monographs and more than 90 refereed papers in his areas of interest, which include decision analysis, negotiation analysis, risk analysis, and Bayesian statistics, and their applications. He is scientific advisor of AISoy Robotics. He is on the editorial board of Decision Analysis. Email: david.rios@urjc.es . Fabrizio Ruggeri (" From the Editors: Games and Decisions in Reliability and Risk ") is the director of research at IMATI CNR (Institute of Applied Mathematics and Information Technology at the Italian National Research Council) in Milano, Italy. He received a B.Sc. in mathematics from the University of Milano, an M.Sc. in statistics from Carnegie Mellon University, and a Ph.D. in statistics from Duke University. After a start as a researcher at Alfa Romeo and then a computer consultant, he has been working at CNR since 1987. His interests are mostly in Bayesian and industrial statistics, especially in robustness, decision analysis, reliability, and stochastic processes; recently, he got involved in biostatistics and biology as well. Dr. Ruggeri is an adjunct faculty member at the Polytechnic Institute (New York University), a faculty member in the Ph.D. program in mathematics and statistics at the University of Pavia, a foreign faculty member in the Ph.D. program in statistics at the University of Valparaiso, and a member of the advisory board of the Ph.D. program in mathematical engineering at Polytechnic of Milano. An ASA Fellow and an ISI elected member, Dr. Ruggeri is the current ISBA (International Society for Bayesian Analysis) president and former ENBIS (European Network for Business and Industrial Statistics) president. He is the editor-in-chief of Applied Stochastic Models in Business and Industry and the Encyclopedia of Statistics in Quality and Reliability, and he is also the Chair of the Bayesian Inference in Stochastic Processes workshops and codirector of the Applied Bayesian Statistics summer school. Email: fabrizio@mi.imati.cnr.it . Juan Carlos Sevillano (" Adversarial Risk Analysis: The Somali Pirates Case ") is a part-time lecturer at the Department of Statistics and Operations Research II (Decision Methods) at the School of Economics of Complutense University. He holds a B.Sc. in mathematics from Complutense University and an M.Sc. in decision systems engineering from Rey Juan Carlos University. Email: sevimjc@ccee.ucm.es . Ross D. Shachter (" Formulating Asymmetric Decision Problems as Decision Circuits ") is an associate professor in the Department of Management Science and Engineering at Stanford University, where his teaching includes probability, decision analysis, and influence diagrams. He has been at Stanford since earning his Ph.D. in operations research from the University of California, Berkeley in 1982, except for two years visiting the Duke University Center for Health Policy Research and Education. His main research focus has been on the communication and analysis of the relationships among uncertain quantities in the graphical representations called Bayesian belief networks and influence diagrams, and in the 1980s he developed the DAVID influence diagram processing system for the Macintosh. His research in medical decision analysis has included the analysis of vaccination strategies and cancer screening and follow-up. At Duke he helped to develop an influence diagram-based approach for medical technology assessment. He has served on the Decision Analysis Society (DAS) of INFORMS Council, chaired its student paper competition, organized the DAS cluster in Nashville, and was honored with its Best Publication Award. For INFORMS, he organized the 1992 Doctoral Colloquium and has been an associate editor in decision analysis for Management Science and Operations Research. He has also served as Program Chair and General Chair for the Uncertainty in Artificial Intelligence Conference. At Stanford he served from 1990 until 2011 as a resident fellow in an undergraduate dormitory, and he was active in planning the university's new student orientation activities and alcohol policy. Email: shachter@stanford.edu . Jim Q. Smith (" Regulating Autonomous Agents Facing Conflicting Objectives: A Command and Control Example ") has been a full professor of statistics at the University of Warwick in the United Kingdom for 18 years, receiving a Ph.D. from Warwick University in 1977, and has more than 100 refereed publications in the area of Bayesian decision theory and related fields. He has particular interests in customizing probabilistic models in dynamic, high-dimensional problems to the practical needs of a decision maker, often using novel graphical approaches. As well as teaching decision analysis to more than 3,000 top math students in the United Kingdom and supervising 23 Ph.D. students in his areas of expertise, he has been chairman of the Risk Initiative and Statistical Consultancy Unit at Warwick for 10 years, engaging vigorously in the university's interaction with industry and commerce. His book Bayesian Decision Analysis: Principles and Practice was published by Cambridge University Press in 2010. Email: j.q.smith@warwick.ac.uk . Refik Soyer (" From the Editors: Games and Decisions in Reliability and Risk ") is a professor of decision sciences and of statistics and the chair of the Department of Decision Sciences at the George Washington University (GWU). He also serves as the director of the Institute for Integrating Statistics in Decision Sciences at GWU. He received his D.Sc. in University of Sussex, England, and B.A. in Economics from Boğaziçi University, Turkey. His areas of interest are Bayesian statistics and decision analysis, stochastic modeling, statistical aspects of reliability analysis, and time-series analysis. He has published more than 90 articles. His work has appeared in journals such as Journal of the American Statistical Association; Journal of the Royal Statistical Society, Ser. B.; Technometrics; Biometrics; Journal of Econometrics; Statistical Science; International Statistical Review; and Management Science. He has also coedited a volume titled Mathematical Reliability: An Expository Perspective. Soyer is an elected member of the International Statistical Institute, a fellow of the Turkish Statistical Association, and a fellow of the American Statistical Association. He was vice president of the International Association for Statistical Computing. He served on the editorial board of the Journal of the American Statistical Association and is currently an associate editor of the Applied Stochastic Models in Business and Industry. Email: soyer@gwu.edu . Fabio Spizzichino (" Interactions Between Ageing and Risk Properties in the Analysis of Burn-in Problems ") is a full professor of probability theory at the Department of Mathematics, the Sapienza University of Rome. He teaches courses on introductory probability, advanced probability, and stochastic processes. In the past, he has also taught courses on basic mathematical statistics, Bayesian statistics, decision theory, and reliability theory. His primary research interests are related to probability theory and its applications. A partial list of scientific activities includes dependence models, stochastic ageing for lifetimes, and (semi-)copulas; first-passage times and optimal stopping times for Markov chains and discrete state-space processes; order statistics property for counting processes in continuous or discrete time, in one or more dimensions; sufficiency concepts in Bayesian statistics and stochastic filtering; and reliability of coherent systems and networks. He also has a strong interest in the connections among the above-mentioned topics and in their applications in different fields. At the present time, he is particularly interested in the relations among dependence, ageing, and utility functions. Email: fabio.spizzichino@uniroma1.it . Sumitra Sri Bhashyam (" Modeling State-Dependent Priorities of Malicious Agents ") is a Ph.D. candidate in the Management Science Group at the London School of Economics (LSE). Her Ph.D. thesis is supervised by Dr. Gilberto Montibeller and cosupervised by Dr. David Lane. Her research interests include decision analysis, multicriteria decision analysis, preference modeling, and preference change. Before coming to study in the United Kingdom, Sri Bhashyam studied mathematics, physics, and computer sciences in France for two years, after which she moved to the United Kingdom to complete a B.A.Hons in marketing communications and then an M.Sc. in operational research from the LSE. She worked as a project manager at Xerox and, subsequently, as a consultant for an SME (small and medium enterprise) to help them set up their quality management system. Alongside the Ph.D., and participating in other research and consultancy projects, she has been a graduate teaching assistant for undergraduate, master, and executive students at the LSE. The courses she teaches include topics such as normative and descriptive decision theory, prescriptive decision analysis, simulation modeling and analysis. Email: s.sribhashyam@lse.ac.uk . Jun Zhuang (" Regulation Games Between Government and Competing Companies: Oil Spills and Other Disasters ") has been an assistant professor of industrial and systems engineering at the University at Buffalo, the State University of New York (SUNY-Buffalo), since he obtained his Ph.D. in industrial engineering in 2008 from the University of Wisconsin–Madison. Dr. Zhuang's long-term research goal is to integrate operations research and game theory to better mitigate, prepare for, respond to, and recover from both natural and man-made hazards. Other areas of interest include healthcare, sports, transportation, supply chain management, and sustainability. Dr. Zhuang's research has been supported by the U.S. National Science Foundation (NSF), by the U.S. Department of Homeland Security (DHS) through the Center for Risk and Economic Analysis of Terrorism Events (CREATE) and National Consortium for the Study of Terrorism and Responses to Terrorism (START), by the U.S. Department of Energy (DOE) through the Oak Ridge National Laboratory (ORNL), and by the U.S. Air Force Office of Scientific Research (AFOSR) through the Air Force Research Laboratory (AFRL). Dr. Zhuang is a fellow of the 2011 U.S. Air Force Summer Faculty Fellowship Program (AF SFFP), sponsored by the AFOSR. Dr. Zhuang is also a fellow of the 2009–2010 Next Generation of Hazards and Disasters Researchers Program, sponsored by the NSF. Dr. Zhuang is on the editorial board of Decision Analysis and is the coeditor of Decision Analysis Today. Email: jzhuang@buffalo.edu .