THE FALL OF A COLONIAL LEGACY: A MODERN HISTORY OF SYRIAN BORDERS (1920-2015)
The Marie Skłodowska-Curie project SYRIANBORDERS worked towards filling in the research gaps on the borders and boundaries of contemporary Syria. Fellow Matthieu Cimino, tells us more about his project.
A historian and political scientist and the author of "Syria: Borders, boundaries, and the state", Matthieu Cimino has devoted his research to the contemporary history of the Near and Middle East. Following his time as a postdoctoral researcher at Tel Aviv University, he took up the post of Marie Skłodowska-Curie researcher at Oxford University in 2016‒2018. It was there he led the SYRIANBORDERS project: The Fall of a Colonial Legacy: A Modern History of Syrian Borders (1920‒2015).
THE SYRIANBORDERS JOURNEY
Introducing the project, Cimino noted: “While working on borders, in particular the borders of Lebanon, Syria, Palestine and Israel, I realised there was one topic I needed to investigate regarding Syria.” He further explained: “Wars and revolutions in Syria have triggered multiple reconfigurations, restructuring the nature of the state, the territory and its borders. While in other countries like Lebanon research has been carried out to study and document changes in its borders, this has not been the case with Syria.”
Cimino aimed to change this through the SYRIANBORDERS project. The researcher worked towards two goals. The first was to contribute to the history of contemporary Syria by analysing the country through the prism of its borders. The second goal was to produce a monograph that would include post ‒2011 dynamics.
As a result of the project, researchers, political actors, civil servants and the public have a greater understanding of post-2011 reconfigurations of the Middle East. “We have learnt how different non-state actors perceive the boundaries of Syria, how relevant they are now, and how have they been configured over time,” confirmed Cimino. He further emphasises that this research is very important as “borders and boundaries are the envelope of the state ‒ charged with important symbolic values.”
Following this project, the researcher will continue to focus on understanding nationalistic ideology and non-state actors by examining Syrian textbooks. This will help ascertain how history and geography are taught to students.
MARIE SKLODOWSKA-CURIE SUPPORT
“Being a Marie Skłodowska-Curie researcher gave me the opportunity to work on this project,” confirmed Cimino. The researcher noted that through the programme he received both personal and professional support. “When you are a researcher it is quite difficult to find a position that is financially rewarding, which I found with the Marie Skłodowska- Curie programme.” He added: “You are also able to, through the programme, do field work and organise conferences. For example, I helped organise an international conference where we brought many researchers from different backgrounds and places to Oxford.” Cimino concluded: “In terms of grants and fellowships, the Marie Skłodowska-Curie programme is one of the best, if not the best.”
The world is currently seeing a surge of digital health start-ups whose solutions usually fall into the general wellness, exercise and diet category, neglecting specific health conditions.
The delivery of health-related services through the use of mobile technologies is called mHealth. The use of mHealth apps has grown exponentially in recent years, with over 100 000 apps available online for download.
These numbers tell of a significant market size and of the ongoing demand for new tools to help people manage their health. Unfortunately, only a fraction of these apps and services take into consideration the perspectives of relevant stakeholders like healthcare professionals, and sometimes even patients themselves.
In order to be effective, technology needs to be designed in a way that is meaningful to those who would use it. My doctoral thesis focused on this problem.
Worldwide, there has been a great change as countries developed and the overall population aged. Gone are the days where predators and nasty infections were the main source of concern; a new kind of ailment now plagues our world and it is known as a chronic condition.
Over 60 % of all deaths are caused by chronic conditions like cancer or heart disease, taking precedence over “traditional” acute illnesses. In fact, thanks to improved living conditions and advances in healthcare, severe and disabling diseases that were considered lethal or used to require hospitalization are now controllable if not curable, letting people live on with them for many years. However, this presents a challenge for continued and prolonged self-management.
The way that technologies have entrenched themselves so deeply into our day-to-day lives has also created rapid changes in our society. We are now seeing patients who actively seek, gather, and make decisions based on online information. In this sense, mobile technologies hold promise for chronic conditions because of their ubiquity, low cost, less invasive nature, and their ability to provide immediate feedback.
There are many behavioural change theories that attempt to explain why we do things, and propose frameworks to be followed in order to create new behaviours. The use of behavioural change models has proven important in developing successful health interventions for chronic disease management. However, understanding human behaviour is a complex task as many elements influence and shape the way we act without us realising it. Some elements are internal while others are external, and the interplay between each of them can determine our perceptions, our beliefs and our willingness to do certain things.
Further, finding ways to engage patients and encourage them to continue with an intervention is a difficult task, leaving designers of mHealth solutions for chronic conditions with no clear way of deciding what factors are relevant to consider.
The doctoral thesis I presented at the University of Oulu, Finland, is the result of an industrial PhD experience that took place in Salumedia Tecnologias, a digital health company in Spain, over the span of my Marie Skłodowska-Curie fellowship in the CHESS ITN programme (MSCA ITN No. 676201). During this time, I was involved in several digital health projects that I used to ground my research.
As part of the company’s ongoing product development, I followed a user-centred design approach to create different mHealth solutions for conditions like breast cancer and multiple sclerosis. In doing so, I explored the negotiations between existing medical knowledge, behavioural change theories and gamification.
As a result of an embedded case study methodology and thematic analysis, certain design factors emerged from the data. They were grouped in the form of three main components to create the “Model for Motivational Mobile-health Design for Chronic conditions” or 3MD model.
The 3MD model is aimed at designers of mHealth solutions and it proposes a series of illustrative questions to assist in the process of creating a digital health solution. The doctoral thesis has recently been awarded the "Best Doctoral Dissertation" distinction by the national Finnish Association of Information and Communication Professionals in consideration to its interdisciplinary value, importance of the topic and excellence of the research.
As technologies continue to emerge and adapt, healthcare will transform into something very different from what we have now. It is up to us, whether we are researchers, designers, healthcare professionals or patients, to decide the shape of things to come. There is so much left to be done, so we should get working.
The 3MD model was published in JMIR Serious Games The full doctoral thesis is available online in the University of Oulu’s repository
The 3MD model's components and its interactions.
Rediscovering the empowering legacies of the EU’s Free Movement of Persons.
The value of historical inquiry to address contemporary migration and asylum policies has been neglected for too long. This has resulted in a harmful disregard of the empowering rediscovery of our common human mobility rights’ legacies, so full of potential to unlock ground-breaking approaches to present-day obstacles.
This is the case of past European integration initiatives and proposals, which are generally ignored when undertaking the current challenges to the European Union’s Free Movement of Persons (FMP). However, such a legacy could even be considered a fundamental intangible heritage, as well as a solid, retroactively innovative and paradigmatically transnational foothold.
LOOKING BACK TO SEE BEYOND
The MSCA-IF Global Fellowship NAVSCHEN (‘Navigating Schengen. Historical Challenges and Potentialities of the EU Free Movement of Persons, 1985-2015’) project aims to look back in order to see beyond by unveiling overlooked historical archives, players and actions in this realm. Indeed, structurally conditioning elements and aborted proposals (roads not taken) can be powerful sources of inspiration for the essential policy area of human mobility rights, linked to a most basic ‘right to have rights’(1).
Critical historical analysis sheds light on:
• Actors’ motivations, strategies and discourses
• Meaning and insights of a given context
• Implications of causal links
• Interdependencies between memories and present directions
• The possibilit of comparing distant, yet conceptually related, case studies
POLICYMAKING USES OF HISTORICAL ANALYSIS
From this perspective, the main policymaking uses of critical historical analysis on the EU’s FMP are dedicated to the following:
• The fact that changing attitudes towards human mobility rights illustrate more profound societal changes to be taken into account from an evidence-based policymaking perspective
• The provision of timely and essential tools to interpret new conceptions of inclusiveness in a globally interconnected society
• Bridging research outputs and global governance objectives by clarifying the links between particular turning points and resulting contexts
• The improvement of our understanding of the intertwined factors conditioning EU borders, membership and belonging
• The building of well-researched countermeasures to the increasing poverty and discrimination of mobile populations, as well as ways of globally fostering a sustainable social solidarity
• The improvement of the modalities of the progressive Europeanisation of immigrants’ integration.
Given the primacy of economic integration over its more socio-political dimensions, the EU’s FMP has been denominated the ‘fourth freedom’ due to its relegation to the other three Schengen Area freedoms of movement: of capital, goods and services. Plus, as the integration of migrant and refugee populations is a crucial issue of global concern, more critical attention could be paid to understanding how the EU’s FMP as a ‘fourth freedom’ is crashing under the weight of ever-growing social inequalities.
In this respect, a promising shift of focus could be centred on promoting sustainable models of upward social mobility. In short, critical historical analysis would decisively aid to reconfigure policy-making debates on profoundly unsettled human mobility rights.
GATEWAY HISTORICAL ARCHIVES
A paradigmatic observatory for such undertakings can be found at the European Parliament (EP)’s archival records on the changing modes of implementation of the EU’s FMP. Indeed, EP decision-makers distinctly searched for a balance between Single Market priorities and the pre-eminence of the FMP as an end in itself within the European integration process. For instance, EP representatives denounced how the aims of the internal market intended to overshadow the defence of democratic rights and freedoms per se. Accordingly, the EP’s influence was reflected in the June 1986 Solemn Declaration by the three Institutions, centred on combating all forms of discrimination, racism or xenophobia. Furthermore, EP discussions on the nascent concept of a ‘Citizens’ Europe’ stressed ‘the value of the contribution made by immigrants to the building of a multinational and multicultural European society’(2).
A MOVEMENT IN THE OPPOSITE DIRECTION
The EU’s FMP is considered one of the most meaningful, and also the most popular accomplishments ever of European integration(3). This socially recognised achievement could be mirrored by an EU that acts, primarily, as an ethically committed political player constantly bringing up the human rights, solidarity and social cohesion dimensions of the European integration process. As we witness a reverse of such developments, critical historical analysis could reignite a commitment to re-establish a decisive dialogue between citizens and institutions, determined to supersede growingly toxic socio-political cleavages. Indeed, this pivotal viewpoint could trace back key EU principles to rekindle the transformative power of policy innovation and lead to positive societal impact: ‘A movement in the opposite direction, free of inconsiderate ambitions’(4).
1 S. DeGooyer, A. Hunt, L. Maxwell, S. Moyn, The Right to Have Rights (Verso Books, New York, 2018).
2 Motion for a Resolution of the EP on the ‘Citizen's Europe’, OJC 497/88262, 13/09/1988, pp. 40-41.
3 C. Offe, Europe Entrapped (Polity Press, Cambridge, 2015), p. 137.
4 H. Martinson, Antología Poética (Barcelona, Plaza & Janés, 1974).
Marie Skłodowska-Curie Global Fellow, University of Pittsburgh / Ca’ Foscari University of Venice
DR. CRISTINA BLANCO SÍO-LÓPEZ
While taking images of exoplanets, astronomers encounter instrumental biases and bright spots in the data. This is due to imperfections in the optomechanical components of the instrument and the telescope. These long-lasting, however evolving patterns either mimic the signal of planets or hide them in the background noise. Garima Singh, the MSCA individual fellow affiliated with Pierre Baudoz at the Observatory of Paris, sheds light on the technology involved in tackling such systematic patterns to improve the image quality of images containing exoplanet signals.
THD2 testbed at the Observatory of Paris where we develop techniques to improve the current capabilities of imaging exoplanets.
Exoplanets are planets in orbit around stars other than our Sun. These alien worlds come in all flavours: Super-Earths, hot Jupiters and mini-Neptunes to name a few. We have sufficient evidence to believe that our solar system with its eight famous planets is not unique and perhaps may not be the only place where life is harboured in the universe. In fact, we have been finding exoplanets that lie just at the right distance from their stars where life-supporting conditions could exist.
Exoplanetically speaking, it is an exciting time for humanity: these wonderful discoveries are opening the doors to the possibility of finding life somewhere else than the Earth. Although such a quest may not help us solve the problems of our world, it can surely give an orbital perspective when one questions the existence of the world we live in. Today, we know more than 4 000 exoplanets. Most of these discoveries were made with indirect methods that confirm the existence of a planet but do not visually perceive it. If a planet orbits a star, then the star wobbles. If a planet passes in front of its star, then the brightness of the star varies periodically. This wobbliness and/ or the change in the brightness of stars is what is observed to indirectly approve the presence of planets around them. By definition, these methods are more favourable in detecting planets with small orbital periods or mature planets like the ones in our solar system. The question is: Can we take images of exoplanets?
Seeing an exoplanet has its own charm but obtaining its image is scientifically essential. Apart from being able to study the chemical and physical composition of the atmosphere of planets, imaging is a powerful way to find liquid water on the surface of a planet. However, the technical requirements to do so are extremely challenging. Current techniques include the high-contrast imaging (HCI) of exoplanets, which consists of taking snapshots of extrasolar systems with ground-based telescopes. With current technological capabilities, it is actually possible to detect young Jupiter-size exoplanets orbiting at large distances, while it is nearly impossible to take images of exoplanets orbiting closer to their stars. Being able to see planets at all possible orbital periods is essential in understanding the formation and evolution of planets in a stellar environment. With this motivation, we astronomers are aiming to image exoplanets at all ranges of orbital periods7. Our project “Exoplanet Finder” funded by the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska- Curie grant agreement No 798909 is dedicated to finding solutions to problems that limit our visual evidence to directly image exoplanets closer to their host stars.
CURRENT TECHNOLOGICAL LIMITS IN IMAGING EXOPLANETS
Ground-based telescopes of 30- metre diameter or more are needed to look deeper and closer to the star to find exoplanets with short orbital periods. We have already entered the era of extremely large telescopes and the construction of an European telescope of 39-metre diameter has already started in the Atacama Desert of Northern Chile. However, it will take at least a decade to be able to image closer-in exoplanets. Given the current limit of 10-metre-class telescopes, at present we simply do not have access to the immediate surrounding of a star. We can image young giant planets at large distances only in favourable observing conditions.
Another requirement is to isolate the faint light of a planet from the overwhelming brightness of its star. In general, a planet signal is roughly 1 000 to 10 billion times fainter than its star. A device called coronagraph is generally used to block the starlight inside the instruments. However, during HCI observations from ground, the Earth’s atmosphere behaves like an oven. The light from a star-planet system is distorted and blurred by our atmospheric turbulence. As a result, coronagraphs do not function as expected. This challenging problem is addressed by the Adaptive Optics (AO) technique. When we point the telescope at a star to search for an exoplanet around it, the routine process includes inspecting the corrupted signal of a star-planet and undoing the effects of Earth’s turbulence every millisecond during an observation.
Once the real-time frames of a star possibly containing the signal from an exoplanet are stabilized on the science camera by an AO system, the starlight is then blocked by a coronagraph. Theoretically, after this process, the signal of an exoplanet should emerge out from the noisy background where the starlight is suppressed. However, it is not yet the case. Since the telescope structure shakes continually and contorts gradually, part of the starlight which should have been suppressed spreads out and creates little 'devils' called speckles which are a lookalike of planetary signals. These speckles evolve in images at different rates and it is challenging to speculate their evolution lifetime. Some of these instrumental patterns can be discarded in post-processing of data while some linger and create false positives. In images, the area closer to the star is polluted by speckles which create confusions during the data interpretation by astronomers, making it difficult to differentiate between speckles and real planetary signals.
PREVENTION BEFORE CURE
We astronomers are very well aware that our images containing signals of exoplanets are contaminated by speckles. It is thus highly desirable in the HCI community to find sturdy solutions that can withstand these speckles and undo their presence whenever they pop-up in the images. In other words, when the telescope is taking exoplanet data then a real-time algorithm should detect the location of these emerging speckles and make them disappear. Our team at the Observatory of Paris8 has pushed the current technological limit and worked on such an algorithm9.
In our laboratory setup, we simulate a star under the environmental condition that imitates the observing scenarios at the Very Large Telescope (VLT) in Chile. First of all, our technique teaches the algorithm to differentiate between the speckles and the planetary signals. An important property of a speckle is that it is generated by the light of the star itself whereas the signal of a planet comes either from its own thermal energy or from the starlight reflected by the planet. Once this knowledge is established, fake speckles with all the possible known brightness are injected into the images at different locations. The algorithm then scans the area of interest in the images and trains itself by building a matrix containing the information of fake speckles. This matrix then acts as a foreknowledge of speckles and is able to identify random speckles that appear during the real observations. Once the location and the brightness of a speckle is identified, the light from this speckle can be diminished (Figure 2, right) with the help of a mirror that has a property of reshaping the light in any desirable form.
One of my projects as an MSCA fellow was to characterize the performance of this technique in simulations and in the laboratory experiments. We demonstrated in an article10 that our real-time algorithm can identify such persisting planet-resembling features and suppress them before post-processing of the data. The published article has a direct impact on improving the capability of the current and future HCI instruments by further clearing up our vision while looking for exoplanets at all possible distances.
9 P. Baudoz, A. Boccaletti, J. Baudrand, D. Rouan, C. Aime, F. Vakili, The Self-Coherent Camera: a new tool for planet detection. IAU Colloq. 200: Direct Imaging of Exoplanets: Science & Techniques, ed., 553–558 (2006).
10 G. Singh, R. Galicher, P. Baudoz, O. Dupuis, M. Ortiz, A. Potier, S. Thijs, E. Huby, Active minimization of non-common path aberrations in long-exposure imaging of exoplanetary systems. Astronomy & Astrophysics, 631, A106 (2019).
Laboratory images of a star as seen by a Very Large Telescope in Chile. The left image simulates a realistic scenario where a star image is filled with speckles as labelled. These speckles mimic signals of exoplanets. The image on the right shows how these speckles are suppressed (the region within the white box) in real-time by the algorithm. It takes roughly 90 seconds to clean the speckles and remove this ambiguity.
The multicenter project on genetic service delivery models for the provision of genomic applications was implemented by the Personalized pREvention of Chronic DIseases consortium (PRECeDI), which is a Marie Skłodowska-Curie Action project funded within the Research and Innovation Staff Exchange scheme.
The Personalized pREvention of Chronic DIseases (PRECeDI) consortium consisted of academic and non-academic institutions addressing different aspects of personalized medicine (PM) through five research domains related to economic evaluations, health services research, ethical-legal and policy issues. In the period 2014‒2018, 58 researchers were seconded for training and research in PM, with specific reference to personalized prevention of chronic diseases (i.e. cancer, cardiovascular, neurodegenerative diseases) (11).
The aim of the 5th domain was to identify current genetic service delivery models for the provision of genetic testing, policies governing the use of genomic applications and methods to evaluate genetic services in Europe and in selected non-European countries (US, Canada, Australia, and New Zealand). The methodological approach included systematic reviews of the literature and structured interviews addressing European healthcare professionals on policies and delivery of genetic services.
Genetic service delivery models for the provision of genetic testing identified through the research are classified into five categories according to the most prominent role of healthcare professionals in patient pathways: i) genetic services led by geneticists; ii) the primary care model; iii) the medical specialist model; iv) genetic services integrated into population screening programs; and v) the direct-to-consumer (DTC) model.
Genetic services led by geneticists correspond to the 'classic' model of genetic services (e.g., for rare diseases) provided mainly by geneticists; this is still the most common model of delivery. However, genetic applications are increasingly utilised by other healthcare professionals who are involved to various degrees in patient management (e.g. different medical specialists, nurses, technicians, midwives). This is particularly evident in genetic services led by medical specialists, which is the second most common model of delivery. Genetic services are also progressively integrated into population-based screening programmes, such as newborn screening, screening for hereditary breast and ovarian cancer, and colorectal cancer. The primary care model is one of the least represented in the study. It has been overshadowed by the medical specialist model in recent years due to lack of or limited knowledge of primary care physicians in genetics. Few DTC genetic services were identified, but the model should be much more common given the easy access to genetic testing offered by commercial companies and the increasing tendency to purchase medical products through the internet12. The integration of genetics in other medical specialties should be promoted through new delivery models involving different healthcare professionals (e.g. medical specialists, nurses, technicians) and new professional roles (i.e. genetic counsellors, genetic associates, genetic nurses), in order to guarantee the use and sustainability of existing and new genomic applications in practice. Roles and responsibilities should be redistributed among different health professionals to enhance work performance and the standard of care.
Most genetic tests have considerable evidence of efficacy and cost-effectiveness and are ready for full implementation in clinical and public health practice (i.e. BRCA1/2, Lynch syndrome, familial hypercholesterolemia). However, not all genetic tests have been evaluated prior to their introduction in routine practice (e.g. cardiovascular conditions, type 2 diabetes, hereditary, hemochromatosis). Prior to implementation in clinical and public health practice, genetic tests should be evaluated based on available efficacy and cost-effectiveness data and offered to citizens as a right to benefit from innovative healthcare.
One of the factors limiting the successful implementation of genomic discoveries into routine practice is the lack of expertise in medical genetics. Another important barrier to implementation is related to funding for genomic research, which is public in most countries. National policies governing the use of genomic applications also affect the proper implementation of genetic discoveries in mainstream medicine. Several countries have not enacted regulations governing the use of genetic applications in clinical and public health practice13. France and Italy are the only countries, among those considered in the project, with a National Plan for Public Health Genomics.
Professional education in genomics medicine, adequate funding, public policies, and public awareness are essential factors for the successful implementation of genomic applications in routine practice. It is advisable to define the appropriate model for genetic service provision in a specific setting according to the type of healthcare system and the genetic test provided.
Based on the results of the project, a set of recommendations for researchers and policymakers has been issued, with the aim to facilitate the integration of PM in the prevention of chronic diseases.
11 How to integrate Personalized Medicine into Prevention? Recommendations from the Personalized pREvention of Chronic Diseases (PRECeDI) consortium (2018); Public Health Genomics. 2019 Dec 5:1-7. doi: 10.1159/000504652 http://www.precedi.eu/docsmedia/communications/pers._medicine_preventio…
12 B. Unim, E. Pitini, T. Lagerberg, G. Adamo, C. De Vito, C. Marzuillo, P. Villari, Current Genetic Service Delivery Models for the Provision of Genetic Testing in Europe: A Systematic Review of the Literature. Front. Genet. 10, 552 (2019). doi: 10.3389/fgene.2019.00552
13 World Health Organization (WHO), "Human Genomics in Global Health. Quality and Safety in Genetic Testing: An Emerging Concern" (WHO, 2003); http://www.who.int/genomics/policy/quality_safety/en/index1.html
BRIGID UNIM, PAOLO VILLARI
DEPARTMENT OF PUBLIC HEALTH AND INFECTIOUS DISEASES, SAPIENZA
UNIVERSITY OF ROME, ROME, ITALY