Meritocracy: the third way and the effervescence of capital

Since the social-democrats dismissed the communist utopia and privileged instead the idea of a well-being founded on the production-consumption cycle, the Western electoral competition has been increasingly focused on the capitalist economy. Accordingly, the political dynamics shifted from the class conflict to the regulation of markets. On the social side, the removal of the previous conflict has freed the "spirit of capitalism" that has been able to settle even more pervasively in the symbolic relations between people. This new philosophy of money triggers a social game played on competition and the reward mechanism derived from it. In this sense, meritocracy is the criterion for governing this new order of capitalism. Within this context, this article discusses the contribution of the left movements and parties, in their historical-social evolution, to the construction of a meritocratic principle in Europe. It also investigates the political process that led the left to a strategic choice, among the other possible options for renewal: namely, to give up to the struggle against capitalism and privilege a progressive accommodative logic with regard to the market. We argue that this choice was based both on values and interests shared by political actors and was supported at a theoretical level by a group of intellectuals who recognize themselves in the Third Way. Based on the above, the article shall identify the main stages in this political change, by using an appropriate selection of discourses and texts that refer to Third Way, analyzing them through a sociological perspective

Meritocracy: the third way and the effervescence of capital

Since the social-democrats dismissed the communist utopia and privileged instead the idea of a well-being founded on the production-consumption cycle, the Western electoral competition has been increasingly focused on the capitalist economy. Accordingly, the political dynamics shifted from the class conflict to the regulation of markets. On the social side, the removal of the previous conflict has freed the "spirit of capitalism" that has been able to settle even more pervasively in the symbolic relations between people. This new philosophy of money triggers a social game played on competition and the reward mechanism derived from it. In this sense, meritocracy is the criterion for governing this new order of capitalism. Within this context, this article discusses the contribution of the left movements and parties, in their historical-social evolution, to the construction of a meritocratic principle in Europe. It also investigates the political process that led the left to a strategic choice, among the other possible options for renewal: namely, to give up to the struggle against capitalism and privilege a progressive accommodative logic with regard to the market. We argue that this choice was based both on values and interests shared by political actors and was supported at a theoretical level by a group of intellectuals who recognize themselves in the Third Way. Based on the above, the article shall identify the main stages in this political change, by using an appropriate selection of discourses and texts that refer to Third Way, analyzing them through a sociological perspective

L' organizzazione del sistema portuale in Italia e in Spagna e prospettive future di armonizzazione a livello europeo The organization of the port system in Italy and Spain and future prospects for harmonization at European level

La tesi sottopone a disamina la normativa italiana e spagnola in tema di organizzazione e gestione dei porti nella cornice comunitaria. Nella prima parte si tratta del quadro legislativo della U.E. con particolare attenzione agli istituti della tutela della libera prestazione dei servizi e della libertà di concorrenza, alla luce del Libro Verde sui Porti Europei. La seconda parte è dedicata alla normativa italiana nel suo complesso dal profilo demaniale alle problematiche connesse con la evoluzione ancora incompiuta della normazione in materia di struttura del sistema portuale dei servizi, operazioni e lavoro portuale, al reperimento delle risorse finanziarie. L’analisi della legislazione spagnola prende spunto da una ricostruzione storica della stessa e sottopone ad indagine tutto l’ordinamento vigente, con speciale riguardo alle LPEyMM del 92, Ley 48/ 2003, Ley 33/2010. La trattazione prosegue con una parte dedicata alla TEN-T ed alla definizione dei porti come nodi delle reti di trasporto, in relazione alla proposta di Regolamento del 23/05/2013 del Parlamento Europeo e del Consiglio che istituisce un quadro normativo per l’ accesso al mercato dei servizi portuali e la trasparenza finanziaria dei porti. Viene infine esposto il disegno di legge governativo riguardante la riforma della legislazione in materia portuale. This thesis examines Italian and Spanish legislation with regard to port organization and governance in a European context. The first part considers the EU legislative framework with special emphasis on measures safeguarding freedom of service provision and of competition in the light of the Green Paper on European Ports. The second part covers the relevant Italian legislation as a whole, ranging from state-owned property issues to problems relating to the so far unaccomplished enactment of laws regulating the system of port services, operations and work, to the raising of financial resources. The analysis of the Spanish port legislation begins with a historical introduction and examines all the regulations in force, with particular reference to these laws: LPEyMM of 92, Ley 48/ 2003, Ley 33/2010. Our discussion continues with a part devoted to TEN-T and the definition of ports as transport hubs, in line with the proposal for a Regulation of the European Parliament and of the Council (of 23 May 2013), establishing a legislative framework for market access to port services and the financial transparency of ports. To conclude, an outline of the Government Bill on Italian port legislation reform is given

Improvement of heart rate recovery after exercise training in older people.

Twenty-four subjects aged 70 and older were retrospectively selected from our archives and screened for symptoms of cardiovascular disease. Baseline exercise test was negative for myocardial ischemia in all subjects. All subjects had completed an 8-week program, performed for a variety of indications and consisting of an aerobic physical training program including 30 minutes of cycling three times per week at 65% to 75% of maximum heart rate achieved at peak exercise test performed at enrollment, an educational intervention, dietary advice, and psychological support. All subjects underwent a cardiopulmonary exercise test (CPX) before and at the end of exercise training. At the end of each CPX, peak oxygen uptake (VO2peak), the rate of increase of ventilation per unit of increase of carbon dioxide production (VE/VCO2slope), and HRR were recorded. Twenty-five healthy subjects younger than 60 with no evidence of exercise-induced myocardial ischemia and not enrolled in any exercise training program were also retrospectively selected from our archives and used as a control group for analyzing HRR. These patients performed two exercise tests several weeks apart. Several studies have shown that changes in vagal tone can be used as an outcome tool that helps identify patients or subjects with or without cardiovascular disease at risk for a cardiovascular event, although the evidence of a prognostic value of HRR in older subjects without cardiovascular disease is rather poor. In this study, exercise training resulted in HRR improvement in healthy elderly subjects, suggesting that exercise training improves vagal/sympathetic balance in older subjects without cardiovascular disease as well. Whether the observed improvement in HRR may have long-term beneficial prognostic effects was not the aim of the study, although a beneficial effect might be postulated, in light of the Framingham dat

Pelvic floor muscle physiotherapy in women with deep infiltrating endometriosis and dyspareunia: a randomized controlled trial

L’obiettivo primario di questo studio prospettico randomizzato controllato è stato valutare gli effetti della terapia riabilitativa del pavimento pelvico in donne con endometriosi profonda e dispareunia superficiale in termini di modificazioni dell’area dello iato pelvico, acquisita mediante ecografia transperineale, durante manovra di Valsalva. Le modificazioni dell'area a riposo e durante contrazione muscolare e la variazione della dispareunia superficiale sono stati analizzati come obiettivi secondari. Sono state arruolate donne nullipare con diagnosi clinica ed ecografica di endometriosi profonda infiltrante e dispareunia superficiale, sottoposte a fisioterapia del pavimento pelvico (gruppo di studio) o al normale iter assistenziale (gruppo di controllo). Le donne sono state sottoposte ad ecografia transperineale 3D e 4D per valutare la morfometria del pavimento pelvico a riposo, durante la contrazione muscolare e la manovra di Valsalva, misurando l’area dello iato pelvico (LHA). I sintomi dolorosi sono stati indagati mediante scala numerica (Numerical Rating Scale). Le donne del gruppo di studio sono state sottoposte a 5 sedute individuali di fisioterapia del pavimento pelvico. I sintomi e l’LHA sono stati rivalutati in tutte le donne dopo 4 mesi dalla prima visita. Ventisette donne hanno completato lo studio (17 nel gruppo di studio e 10 nel gruppo di controllo). Dopo la fisioterapia nel gruppo di studio abbiamo osservato un incremento significativamente più marcato dell'LHA durante la manovra di Valsalva, con una differenza complessiva tra i due gruppi pari al 20.7%. Inoltre nel gruppo di studio abbiamo riscontrato una riduzione significativa della dispareunia superficiale (Δ medio = –3.1 ± 2.7, P < 0.001) e del dolore pelvico cronico (Δ medio = –1.1 ± 1.9, P = 0.021). Nelle donne con endometriosi profonda la terapia riabilitativa del pavimento pelvico sembra dunque essere efficace nel migliorare la capacità di rilasciamento muscolare, valutata mediante ecografia transperinale, la dispareunia superficiale ed il dolore pelvico cronico.The primary aim of this randomized controlled trial was to evaluate the effects of PFM physiotherapy in women with deep infiltrating endometriosis (DIE) and superficial dyspareunia in terms of pelvic floor morphometry (PFM) modifications at transperineal ultrasound during Valsalva maneuver. Modifications of PFM at rest and during pelvic floor contraction and variations of superficial dyspareunia were also analyzed as secondary outcomes. We recruited a series of nulliparous women, with clinical or sonographic diagnosis of DIE and associated superficial dyspareunia. All women underwent a first examination to assess the Levator Hiatus Area (LHA) with a 3-D/4-D transperineal ultrasound at rest, at maximum pelvic floor muscle (PFM) contraction and during maximum Valsalva maneuver; moreover pain symptoms were evaluated using a Numerical Rating Scale (NRS). Subsequently, women were randomized into 2 groups: women submitted to five individual sessions of pelvic floor physiotherapy at weeks 1, 3, 5, 8, 11 from the first examination (study group) and women submitted to normal care (control group). After 4 months from the first examination (second examination), pain symptoms and LHA were reassessed in all women. Twenty-seven women completed the study, 17 in the study group and 10 in the control group. After physiotherapy, in the study group the enlargement of LHA was significantly greater at maximum Valsalva maneuver in comparison with the control group, with a difference between the 2 groups of 20.7%. Moreover, in the study group we detected a significant reduction of superficial dyspareunia (mean Δ = –3.1 ± 2.7, P < 0.001) and chronic pelvic pain (mean Δ = –1.1 ± 1.9, P = 0.021) at second examination. In women with DIE pelvic floor physiotherapy seems to be effective in improving pelvic floor muscle relaxation, evaluated with transperineal ultrasound, superficial dyspareunia and chronic pelvic pain

El plan de desarrollo de las personas y su relación con el desempeño laboral de la unidad de gestión de recursos humanos del organismo de evaluación y fiscalización ambiental, 2018

La presente investigación tuvo como objetivo determinar la relación del Plan de Desarrollo de las Personas con el desempeño laboral de la Unidad de Gestión de Recursos Humanos del Organismo de Evaluación y Fiscalización Ambiental, 2018. El trabajo de investigación consta de seis capítulos, a continuación, se hace una breve descripción de cada uno de ellos: El capítulo I, “Planteamiento del estudio”, contiene lo referente al planteamiento del problema, los objetivos de la investigación, la justificación e importancia. El capítulo II, “Marco Teórico Conceptual”, contiene los antecedentes del problema, los antecedentes de la investigación, los fundamentos teóricos y la definición de términos básicos. El capítulo III, “Hipótesis y variables”, se presentan las hipótesis y presentación de las variables. El capítulo IV, “Método”, contiene el tipo y método además del diseño de la investigación, se presenta la muestra de estudio así como la población e instrumentos utilizados, en el capítulo V, “Resultados y Discusión” se presenta los resultados de la investigación y las discusión con otros resultados, en el capítulo VI, “Conclusiones y Recomendaciones” se presenta lo concluido y las recomendaciones o sugerencias del caso, y finalmente se presentan las referencias bibliográficas y los anexos correspondientes. La muestra para el enfoque cuantitativo fue de un censo a los 21 servidores públicos de la Unidad de Gestión de Recursos Humanos - UGRH. Para la recolección de datos se utilizó el cuestionario. Finalmente se concluyó que el Plan de Desarrollo de las Personas se relaciona significativamente con el desempeño laboral de la UGRH del Organismo de Evaluación y Fiscalización Ambiental en año 2018.Tesi

Antibiotics for exacerbations of asthma.

BACKGROUND: Asthma is a chronic respiratory condition that affects over 300 million adults and children worldwide. It is characterised by wheeze, cough, chest tightness, and shortness of breath. Symptoms typically are intermittent and may worsen over a short time, leading to an exacerbation. Asthma exacerbations can be serious, leading to hospitalisation or even death in rare cases. Exacerbations may be treated by increasing an individual's usual medication and providing additional medication, such as oral steroids. Although antibiotics are sometimes included in the treatment regimen, bacterial infections are thought to be responsible for only a minority of exacerbations, and current guidance states that antibiotics should be reserved for cases in which clear signs, symptoms, or laboratory test results are suggestive of bacterial infection. OBJECTIVES: To determine the efficacy and safety of antibiotics in the treatment of asthma exacerbations. SEARCH METHODS: We searched the Cochrane Airways Trials Register, which contains records compiled from multiple electronic and handsearched resources. We also searched trial registries and reference lists of primary studies. We conducted the most recent search in October 2017. SELECTION CRITERIA: We included studies comparing antibiotic therapy for asthma exacerbations in adults or children versus placebo or usual care not involving an antibiotic. We allowed studies including any type of antibiotic, any dose, and any duration, providing the aim was to treat the exacerbation. We included parallel studies of any duration conducted in any setting and planned to include cluster trials. We excluded cross-over trials. We included studies reported as full-text articles, those published as abstracts only, and unpublished data. DATA COLLECTION AND ANALYSIS: At least two review authors screened the search results for eligible studies. We extracted outcome data, assessed risk of bias in duplicate, and resolved discrepancies by involving another review author. We analysed dichotomous data as odds ratios (ORs) or risk differences (RDs), and continuous data as mean differences (MDs), all with a fixed-effect model. We described skewed data narratively. We graded the results and presented evidence in 'Summary of findings' tables for each comparison. Primary outcomes were intensive care unit/high dependence unit (ICU/HDU) admission, duration of symptoms/exacerbations, and all adverse events. Seconday outcomes were mortality, length of hospital admission, relapse after index presentation, and peak expiratory flow rate (PEFR). MAIN RESULTS: Six studies met our inclusion criteria and included a total of 681 adults and children with exacerbations of asthma. Mean age in the three studies in adults ranged from 36.2 to 41.2 years. The three studies in children applied varied inclusion criteria, ranging from one to 18 years of age. Five studies explicitly excluded participants with obvious signs and symptoms of bacterial infection (i.e. those clearly meeting current guidance to receive antibiotics). Four studies investigated macrolide antibiotics, and two studies investigated penicillin (amoxicillin and ampicillin) antibiotics; both studies using penicillin were conducted over 35 years ago. Five studies compared antibiotics versus placebo, and one was open-label. Study follow-up ranged from one to twelve weeks. Trials were of varied methodological quality, and we were able to perform only limited meta-analysis.None of the included trials reported ICU/HDU admission, although one participant in the placebo group of a study including children with status asthmaticus experienced a respiratory arrest and was ventilated. Four studies reported asthma symptoms, but we were able to combine results for only two macrolide studies of 416 participants; the MD in diary card symptom score was -0.34 (95% confidence interval (CI) -0.60 to -0.08), with lower scores (on a 7 point scale) denoting improved symptoms. Two macrolide studies reported symptom-free days. One study of 255 adults authors reported the percentage of symptom-free days at 10 days as 16% in the antibiotic group and 8% in the placebo group. In a further study of 40 children study authors reported significantly more symptom-free days at all time points in the antibiotic group compared with the usual care group. The same study reported the duration in days of the index asthma exacerbation, again favouring the antibiotic group. One study of a penicillin including 69 participants reported asthma symptoms at hospital discharge; the between-group difference for both studies was reported as non-significant.We combined data for serious adverse events from three studies involving 502 participants, but events were rare; the three trials reported only 10 events: five in the antibiotic group and five in the placebo group. We combined data for all adverse events (AEs) from three studies, but the effect estimate is imprecise (OR 0.99, 95% CI 0.69 to 1.43). No deaths were reported in any of the included studies.Two studies investigating penicillins reported admission duration; neither study reported a between-group difference. In one study (263 participants) of macrolides, two participants in each arm were reported as experiencing a relapse, defined as a further exacerbation, by the six-week time points. We combined PEFR endpoint results at 10 days for two macrolide studies; the result favoured antibiotics over placebo (MD 23.42 L/min, 95% CI 5.23 to 41.60). One study in children reported the maximum peak flow recorded during the follow-up period, favouring the clarithromycin group, but the confidence interval includes no difference (MD 38.80, 95% CI -11.19 to 88.79).Grading of outcomes ranged from moderate to very low quality, with quality of outcomes downgraded for suspicion of publication bias, indirectness, imprecision, and poor methodological quality of studies. AUTHORS' CONCLUSIONS: We found limited evidence that antibiotics given at the time of an asthma exacerbation may improve symptoms and PEFR at follow-up compared with standard care or placebo. However, findings were inconsistent across the six heterogeneous studies included, two of the studies were conducted over 30 years ago and most of the participants included in this review were recruited from emergency departments, limiting the applicability of findings to this population. Therefore we have limited confidence in the results. We found insufficient evidence about several patient-important outcomes (e.g. hospital admission) to form conclusions. We were unable to rule out a difference between groups in terms of all adverse events, but serious adverse events were rare

Vitamin D: Daily vs. Monthly Use in Children and Elderly-What Is Going On?

Vitamin D deficiency is highly prevalent among children and adults worldwide. Agreement exists that vitamin D deficiency should be corrected. However, the definitions of vitamin deficiency and effective vitamin D replacement therapy are inconsistent in the literature. Not only is the dosing regimen still under debate, but also the time and period of administration (i.e., daily vs. monthly dose). In pediatric as well as elderly subjects, dosing regimens with high vitamin D doses at less frequent intervals were proposed to help increase compliance to treatment: these became widespread in clinical practice, despite mounting evidence that such therapies are not only ineffective but potentially harmful, particularly in elderly subjects. Moreover, in the elderly, high doses of vitamin D seem to increase the risk of functional decline and are associated with a higher risk of falls and fractures. Achieving good adherence to recommended prophylactic regimens is definitely one of the obstacles currently being faced in view of the wide segment of the population liable to the treatment and the very long duration of prophylaxis. The daily intake for extended periods is in fact one of the frequent causes of therapeutic drop-outs, while monthly doses of vitamin D may effectively and safely improve patient compliance to the therapy. The aim of our paper is a quasi-literature review on dosing regimens among children and elderly. These two populations showed a particularly significant beneficial effect on bone metabolism, and there could be different outcomes with different dosing regimens

Vulnerable personality and Takotsubo cardiomyopathy consequent to emotional stressful events: a clinical case report

Introduction: Although the onset of Takotsubo cardiomyopathy (TTC) can be triggered by an acute, intense emotional stress, the exact pathogenic mechanisms still remain undefined. Presentation: A 58-year-old female was sent by ambulance to the Emergency Department (ED) for chest pain and ST elevations on ECG. Her chest pain began 3 hours before on admission after a domestic argument. Transthoracic echocardiogram showed severe systolic dysfunction with an ejection fraction of 20%. Cardiac catheterization revealed no significant coronary artery disease. The left ventriculogram showed apical ballooning with hyperdynamic proximal segments. A diagnosis of Takotsubo Cardiomyophaty (TTC) was made according to the Mayo Clinic 2008 criteria. The patient evolved with improvement of her condition and, therefore, was discharged from the hospital. Follow-up echocardiogram seven days later showed normal LV size and function with ejection fraction (EF) of 43%. Paykel Life Stress Event Scale identified as emotional trigger a domestic argument occurred 3 hours before symptom onset. History showed a major life stress event, death of a loved one, six months before symptoms. The patient underwent psychological assessment after hospital discharge by Emotional Regulation Questionnaire and BDI showing high suppression/ low reappraisal profile and moderate depression. Conclusion: This case highlights the hypothesis of a possible link between cognitive emotional processing and vulnerability to Takotsubo syndrome