Truth, Knowledge, and Democratic Authority in the Public Health Debate

Quality of democratic arrangements does matter. This kind of conceptual breakthrough has been made through painfully engagement with the nonphilosophical area of inquiry arisen by the COVID-19 pandemic. The pandemic has dramatically emphasized that health is a highly political domain. No surprise then that it made possible to challenge common thought about democratic procedures in political theory that considers procedure-independent standards suspicious. Therefore it is fair to state that the COVID-19 pandemic has taken the quality of democratic outcomes back on center stage in the debate in political theory, which has been dominated by fair proceduralism’s claim not to refer to any procedure-independent standards of good political decisions. Procedural values have traditionally been seen as a defining element of fair deliberation and essential for democracy. They have been extolled in social choice theory that claims that democracy does not exhibit any particular disposition to lead to good or just political arrangements. They are the focus of attention in Jürgen Habermas’ procedural rationality, though philosophers are now more skeptical about the divorce between procedures and substantive standards. Overall, issues surrounding the topic of ensuring citizens’ health make the topic politically central and philosophically interesting for epistemic theories and impartial proceduralism theories of democracy alike. The aim of this paper is to justify the legitimacy and authority of public health policies on the basis of arguments that do not simply are a matter of their being democratic. In the first part, I want to display and criticize the idea that proceduralism’s not getting one’s hands dirty with the substance of decisions and remaining neutrally adherent only to procedures is untenable in the present case. Having criticized democratic theories that want to restrict themselves to purely procedural values, in the second part I will focus on the idea of knowledge and make explicit its characters of being practical and shared. Eventually, it will help to have one example. M-Health will show that many valuable insights would be incompatible with the restrictions of the proceduralism. Philosophical consideration of health will combine epistemic issues with political ones triggered by technology and sharpened by the COVID-19 pandemic

La complessit? della comunicazione scientifica in ambito epidemiologico: il caso Sebiorec

noViene presentata l\u27esperienza in corso nella Regione Campania per accomp agnare la trasmissione dei risultati dell\u27indagine epidemiologica Sebiorec, svolta tramite campionamento di sangue e latte materno. Si ? ritenuto cruciale dedicare particolare attenzione alle problematiche della comunicazione, grazie alla costituzione di un gruppo multidisciplinare, che ha contribuito alla realizzazione di una indagine qualitativa basata su interviste in profondit? e che fornir? strumenti utili alla comunicazione dei risultati. L\u27esperienza si inscrive nell\u27obiettivo di far evolvere l\u27approccio epidemiologico classico verso una eco-epidemiologia basata sull\u27integrazione di conoscenze sull\u27individuo e sulla comunit?, attraverso lo studio dei fattori di rischio, di esposizione e suscettibilit? individuale e di contesto sociale

Assessment of severity in aortic stenosis – Incremental value of endocardial function parameters compared to standard indexes

Several studies have reported that patients (pts) with severe aortic stenosis and similar pressure gradients or even similar aortic valve areas may have quite different symptomatic status and clinical outcomes suggesting that other factors might have a significant impact on the pathophysiology of this disease. Our purpose was to assess the severity of subendocardial wall dysfunction in symptomatic and asymptomatic pts with aortic stenosis using tissue Doppler imaging (TDI), strain rate imaging (SRI) and cyclic variation of integrated backscatter (IB). We studied 68 pts with aortic valvar stenosis and 46 subjects with no signs of heart disease. SRI/IB indexes were calculated in the apical four chambers views at endocardial level. Early diastolic endocardial strain rate showed the best correlation with transvalvar pressure gradients and valve areas. Compared with controls, symptomatic pts showed a more marked decrease in endocardial strain, strain rate and cyclic variation of IB. Receiver operating characteristic (ROC) curves suggested that the thresholds offering an adequate compromise between sensitivity and specificity for the prediction of symptoms were >/=60 mm Hg for the pressure gradient, less than 0.60 cm(2)/m(2) for aortic valve area, less than 20% for strain, less than 2.0 s(-1) for strain rate and less than 3.0 dB for cyclic variation. The combination of pressure gradient, aortic valve area and SRI/IB parameters resulted in an improvement of the overall performance for predicting the symptomatic state. Thus, SRI/IB parameters have an incremental value in differentiating symptomatic and asymptomatic pts with aortic stenosis compared with conventional hemodynamic parameters

Assessment of ascending aorta distensibility after successful coarctation repair by strain Doppler echocardiography

BACKGROUND: Increased arterial stiffness may participate in the genesis of hypertension and increase of left ventricular (LV) mass after surgical correction of coarctation of the aorta. The purpose of the current study was to assess the aortic elastic properties using Doppler tissue imaging and strain rate imaging in patients after coarctoplasty. METHODS: Echocardiography with Doppler tissue/strain rate imaging capabilities was performed in 26 adult normotensive patients who had successful repair of coarctation of the aorta in infancy and in 24 control subjects. Transesophageal aortic transverse sections were imaged at the level of the proximal and distal segments to the repair site. Doppler tissue imaging wall velocities during systole (S(w)), early relaxation (E(w)), and atrial systole (A(w)) and peak systolic strain (ps epsilon) were measured in both groups. Transthoracic ascending aorta (AAo) measurements were also obtained. RESULTS: In the patients with coarctoplasty, S(w) velocities and ps epsilon were significantly decreased in the proximal segments compared with control subjects. Both peak systolic blood pressure after exercise (P < .001) and pulse pressure after exercise (P < .001) were directly related to AAo wall strain. LV annular early diastolic velocity was significantly reduced compared with control subjects in patients with decreased AAo wall strain and exercise-induced hypertension (P < .001) and related to AAo wall velocity (P < .005) and strain (P < .001). In multiple linear regression analysis, only weight, study group, and AAo wall strain were correlated to LV mass index. CONCLUSIONS: Patients with coarctation of the aorta have reduced proximal aortic wall velocities and strain and increased stiffness even after successful repair. This amplifies stress-induced hypertension and increases LV burden

Symbolic universes between present and future of Europe:First results of the map of European societies' cultural milieu

This paper reports the framework, method and main findings of an analysis of cultural milieus in 4 European countries (Estonia, Greece, Italy, and UK). The analysis is based on a questionnaire applied to a sample built through a two-step procedure of post-hoc random selection from a broader dataset based on an online survey. Responses to the questionnaire were subjected to multidimensional analysis–a combination of Multiple Correspondence Analysis and Cluster Analysis. We identified 5 symbolic universes, that correspond to basic, embodied, affect-laden, generalized worldviews. People in this study see the world as either a) an ordered universe; b) a matter of interpersonal bond; c) a caring society; d) consisting of a niche of belongingness; e) a hostile place (others’ world). These symbolic universes were also interpreted as semiotic capital: they reflect the capacity of a place to foster social and civic development. Moreover, the distribution of the symbolic universes, and therefore social and civic engagement, is demonstrated to be variable across the 4 countries in the analysis. Finally, we develop a retrospective reconstruction of the distribution of symbolic universes as well as the interplay between their current state and past, present and future socio-institutional scenarios

Toponymy of the Murter island, University of Zadar, Center of the Adriatic onomastic research, Onomastica Adriatica Series, vol. 4 (chief editor Vladimir Skračić), Zadar, 2010

[This corrects the article DOI: 10.1371/journal.pone.0189885.]

A novel approach of homozygous haplotype sharing identifies candidate genes in autism spectrum disorder

Autism spectrum disorder (ASD) is a highly heritable disorder of complex and heterogeneous aetiology. It is primarily characterized by altered cognitive ability including impaired language and communication skills and fundamental deficits in social reciprocity. Despite some notable successes in neuropsychiatric genetics, overall, the high heritability of ASD (~90%) remains poorly explained by common genetic risk variants. However, recent studies suggest that rare genomic variation, in particular copy number variation, may account for a significant proportion of the genetic basis of ASD. We present a large scale analysis to identify candidate genes which may contain low-frequency recessive variation contributing to ASD while taking into account the potential contribution of population differences to the genetic heterogeneity of ASD. Our strategy, homozygous haplotype (HH) mapping, aims to detect homozygous segments of identical haplotype structure that are shared at a higher frequency amongst ASD patients compared to parental controls. The analysis was performed on 1,402 Autism Genome Project trios genotyped for 1 million single nucleotide polymorphisms (SNPs). We identified 25 known and 1,218 novel ASD candidate genes in the discovery analysis including CADM2, ABHD14A, CHRFAM7A, GRIK2, GRM3, EPHA3, FGF10, KCND2, PDZK1, IMMP2L and FOXP2. Furthermore, 10 of the previously reported ASD genes and 300 of the novel candidates identified in the discovery analysis were replicated in an independent sample of 1,182 trios. Our results demonstrate that regions of HH are significantly enriched for previously reported ASD candidate genes and the observed association is independent of gene size (odds ratio 2.10). Our findings highlight the applicability of HH mapping in complex disorders such as ASD and offer an alternative approach to the analysis of genome-wide association data