A philosophy of home: a study on an alternative experience of domesticity

The major objective of this thesis is to provide an alternative to the predominant model of the Western urban home, arguing that it is more detrimental than beneficial to its inhabitants. In order to achieve this, it first explores the development of home through a genealogical analysis. It then considers the concepts with which it is traditionally connected, such as those of identity, safety, privacy and satisfaction, supporting that the idealised home hides numerous issues of concern (e.g. class and sex inequalities, physical and psychological violence). In order to form a more comprehensive picture, the thesis draws on different philosophical approaches discussing the idea of home, while it explores a variety of contemporary habitation and home-making practices (e.g. smart and second homes, new technologies inside the house, home and consumerism). The normative and overly-idealised domestic model, promoted in Western urban societies, is presented as detrimental both on a personal and on a social level. Therefore, alternatives are explored in Adorno’s ‘Hotel Room’, Jameson’s ‘Dirty Realism’ and Deleuze and Guattari’s ‘Nomadology’. The lack of viability characterising the abovementioned proposals leads to the examination of the Deleuzoguattarian concept of the Body without Organs; the home as a BwO provides the contemporary agents with the tools to reconstruct an autonomous space where they can recreate their personal discourse and influence the social ground accordingly. Through the analysis of home this thesis explores how and why it has been appropriated by systemic forces and highlights a very serious issue: the fact that our personal space is no longer personal. Simultaneously, a common concern of feminist and post-structuralist background is addressed regarding the process of self-redefinition and the ways to approach it. The response entails a reconstructed autonomous home with a respective influence on the public sphere

Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy in TYpe 2 diabetic patients with normoalbuminuria (PRIORITY): essential study design and rationale of a randomised clinical multicentre trial

Introduction: Diabetes mellitus affects 9% of the European population and accounts for 15% of healthcare expenditure, in particular, due to excess costs related to complications. Clinical trials aiming for earlier prevention of diabetic nephropathy by renin angiotensin system blocking treatment in normoalbumuric patients have given mixed results. This might reflect that the large fraction of normoalbuminuric patients are not at risk of progression, thereby reducing power in previous studies. A specific risk classifier based on urinary proteomics (chronic kidney disease (CKD)273) has been shown to identify normoalbuminuric diabetic patients who later progressed to overt kidney disease, and may hold the potential for selection of high-risk patients for early intervention. Combining the ability of CKD273 to identify patients at highest risk of progression with prescription of preventive aldosterone blockade only to this high-risk population will increase power. We aim to confirm performance of CKD273 in a prospective multicentre clinical trial and test the ability of spironolactone to delay progression of early diabetic nephropathy. Methods and analysis: Investigator-initiated, prospective multicentre clinical trial, with randomised double-masked placebo-controlled intervention and a prospective observational study. We aim to include 3280 type 2 diabetic participants with normoalbuminuria. The CKD273 classifier will be assessed in all participants. Participants with high-risk pattern are randomised to treatment with spironolactone 25 mg once daily, or placebo, whereas, those with low-risk pattern will be observed without intervention other than standard of care. Treatment or observational period is 3 years. The primary endpoint is development of confirmed microalbuminuria in 2 of 3 first morning voids urine samples. Ethics and dissemination: The study will be conducted under International Conference on Harmonisation – Good clinical practice (ICH-GCP) requirements, ethical principles of Declaration of Helsinki and national laws. This first new biomarker-directed intervention trial aiming at primary prevention of diabetic nephropathy may pave the way for personalised medicine approaches in treatment of diabetes complications

Multicentre prospective validation of a urinary peptidome-based classifier for the diagnosis of type 2 diabetic nephropathy

Background Diabetic nephropathy (DN) is one of the major late complications of diabetes. Treatment aimed at slowing down the progression of DN is available but methods for early and definitive detection of DN progression are currently lacking. The ‘Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In TYpe 2 diabetic patients with normoalbuminuria trial' (PRIORITY) aims to evaluate the early detection of DN in patients with type 2 diabetes (T2D) using a urinary proteome-based classifier (CKD273). Methods In this ancillary study of the recently initiated PRIORITY trial we aimed to validate for the first time the CKD273 classifier in a multicentre (9 different institutions providing samples from 165 T2D patients) prospective setting. In addition we also investigated the influence of sample containers, age and gender on the CKD273 classifier. Results We observed a high consistency of the CKD273 classification scores across the different centres with areas under the curves ranging from 0.95 to 1.00. The classifier was independent of age (range tested 16-89 years) and gender. Furthermore, the use of different urine storage containers did not affect the classification scores. Analysis of the distribution of the individual peptides of the classifier over the nine different centres showed that fragments of blood-derived and extracellular matrix proteins were the most consistently found. Conclusion We provide for the first time validation of this urinary proteome-based classifier in a multicentre prospective setting and show the suitability of the CKD273 classifier to be used in the PRIORITY tria

Early detection of diabetic kidney disease by urinary proteomics and subsequent intervention with spironolactone to delay progression (PRIORITY): a prospective observational study and embedded randomised placebo-controlled trial

Background: Microalbuminuria is an early sign of kidney disease in people with diabetes and indicates increased risk of cardiovascular disease. We tested whether a urinary proteomic risk classifier (CKD273) score was associated with development of microalbuminuria and whether progression to microalbuminuria could be prevented with the mineralocorticoid receptor antagonist spironolactone. Methods: In this multicentre, prospective, observational study with embedded randomised controlled trial (PRIORITY), we recruited people with type 2 diabetes, normal urinary albumin excretion, and preserved renal function from 15 specialist centres in ten European countries. All participants (observational cohort) were tested with the CKD273 classifier and classified as high risk (CKD273 classifier score >0·154) or low risk (≤0·154). Participants who were classified as high risk were entered into a randomised controlled trial and randomly assigned (1:1), by use of an interactive web-response system, to receive spironolactone 25 mg once daily or matched placebo (trial cohort). The primary endpoint was development of confirmed microalbuminuria in all individuals with available data (observational cohort). Secondary endpoints included reduction in incidence of microalbuminuria with spironolactone (trial cohort, intention-to-treat population) and association between CKD273 risk score and measures of impaired renal function based on estimated glomerular filtration rate (eGFR; observational cohort). Adverse events (particularly gynaecomastia and hyperkalaemia) and serious adverse events were recorded for the intention-to-treat population (trial cohort). This study is registered with the EU Clinical Trials Register (EudraCT 20120-004523-4) and ClinicalTrials.gov (NCT02040441) and is completed. Findings: Between March 25, 2014, and Sept 30, 2018, we enrolled and followed-up 1775 participants (observational cohort), 1559 (88%) of 1775 participants had a low-risk urinary proteomic pattern and 216 (12%) had a high-risk pattern, of whom 209 were included in the trial cohort and assigned to spironolactone (n=102) or placebo (n=107). The overall median follow-up time was 2·51 years (IQR 2·0–3·0). Progression to microalbuminuria was seen in 61 (28%) of 216 high-risk participants and 139 (9%) of 1559 low-risk participants (hazard ratio [HR] 2·48, 95% CI 1·80–3·42; p<0·0001, after adjustment for baseline variables of age, sex, HbA1c, systolic blood pressure, retinopathy, urine albumin-to-creatinine ratio [UACR], and eGFR). Development of impaired renal function (eGFR <60 mL/min per 1·73 m2) was seen in 48 (26%) of 184 high-risk participants and 119 (8%) of 1423 low-risk participants (HR 3·50; 95% CI 2·50–4·90, after adjustment for baseline variables). A 30% decrease in eGFR from baseline (post-hoc endpoint) was seen in 42 (19%) of 216 high-risk participants and 62 (4%) of 1559 low-risk participants (HR 5·15, 95% CI 3·41–7·76; p<0·0001, after adjustment for basline eGFR and UACR). In the intention-to-treat trial cohort, development of microalbuminuria was seen in 35 (33%) of 107 in the placebo group and 26 (25%) of 102 in the spironolactone group (HR 0·81, 95% CI 0·49–1·34; p=0·41). In the safety analysis (intention-to-treat trial cohort), events of plasma potassium concentrations of more than 5·5 mmol/L were seen in 13 (13%) of 102 participants in the spironolactone group and four (4%) of 107 participants in the placebo group, and gynaecomastia was seen in three (3%) participants in the spironolactone group and none in the placebo group. One patient died in the placebo group due to a cardiac event (considered possibly related to study drug) and one patient died in the spironolactone group due to cancer, deemed unrelated to study drug. Interpretation: In people with type 2 diabetes and normoalbuminuria, a high-risk score from the urinary proteomic classifier CKD273 was associated with an increased risk of progression to microalbuminuria over a median of 2·5 years, independent of clinical characteristics. However, spironolactone did not prevent progression to microalbuminuria in high-risk patients. Funding: European Union Seventh Framework Programme

Regere animas : Bernard of Clairvaux's ways of handling heresy as a technology of power

Bernard of Clairvaux's engagement in the struggle against heresy in the 12th century has so far been understood as a logical result of his ecclesiology. In his effort to defend the unity of Christianity, the abbot fought against heresy, as, for him, it represented a major threat to the Church. However, the reverse question of what Bernard's anti-heretical writing brings to the understanding of his ecclesiology has remained almost entirely unexplored, despite the importance of these polemical writings for the "discovery" of Bernard. This article seeks to fill this gap by placing Bernard's anti-heretical discourse at the centre of inquiry in order to understand a crucial aspect of his ecclesiology and to follow how this ecclesiology was realized through specific means against heresy, these functioning as disciplinary practices. Using the theoretical works of Michel Foucault and Talal Asad and insights of modern sociology, the goal is to examine both the way in which the means against heresy operated and the logic behind them. In this way, the article demonstrates the process through which a discourse is articulated and imposed on society and, at the same time, through which a specific subjectivity is shaped and regulated.Bernard of Clairvaux's engagement in the struggle against heresy in the 12th century has so far been understood as a logical result of his ecclesiology. In his effort to defend the unity of Christianity, the abbot fought against heresy, as, for him, it represented a major threat to the Church. However, the reverse question of what Bernard's anti-heretical writing brings to the understanding of his ecclesiology has remained almost entirely unexplored, despite the importance of these polemical writings for the "discovery" of Bernard. This article seeks to fill this gap by placing Bernard's anti-heretical discourse at the centre of inquiry in order to understand a crucial aspect of his ecclesiology and to follow how this ecclesiology was realized through specific means against heresy, these functioning as disciplinary practices. Using the theoretical works of Michel Foucault and Talal Asad and insights of modern sociology, the goal is to examine both the way in which the means against heresy operated and the logic behind them. In this way, the article demonstrates the process through which a discourse is articulated and imposed on society and, at the same time, through which a specific subjectivity is shaped and regulated

Ευρωπαϊκός κοινωνικός πυλώνας, κανόνες ήπιου δικαίου και η αντιμετώπιση της φτώχειας στην Ευρωπαϊκή Ένωση

Η παρούσα διπλωματική εργασία εξετάζει το κοινωνικό φαινόμενο της φτώχειας στην Ευρωπαϊκή Ένωση, και συγκεκριμένα τις νομικές ενέργειες που έχει υιοθετήσει η Ευρωπαϊκή Ένωση τις τελευταίες δεκαετίες για να αντιμετωπίσει αυτό το πολυσύνθετο φαινόμενο. Σκοπός της παρούσας εργασίας είναι να προσπαθήσει να παρουσιάσει την αλλαγή της στάσης της Ευρωπαϊκής Ένωσης που επήλθε μέσα στο πέρασμα των δεκαετιών από μία οικονομική οντότητα σε μία ένωση που θέλει να αναδείξει την κοινωνική της διάσταση και να αναλάβει ενέργειες για να μπορέσει να αντιμετωπίσει τα κοινωνικά προβλήματα που την ταλανίζουν, όπως αυτά της φτώχειας και του κοινωνικού αποκλεισμού. Στο πλαίσιο αυτού του σκοπού θα αναλυθούν: οι στρατηγικές και τα εργαλεία που έχουν υιοθετηθεί από την Ευρωπαϊκή Ένωση για τη θεμελίωση της κοινωνικής της διάστασης, όπως η εισαγωγή και η λειτουργία της Ανοιχτής Μεθόδου Συντονισμού, του Ευρωπαϊκού Εξαμήνου ως του πλαισίου διακυβέρνησης, η υιοθέτηση και η δομή του Ευρωπαϊκού Πυλώνα των Κοινωνικών Δικαιωμάτων, η εφαρμογή του Πυλώνα στο πλαίσιο του σχεδίου δράσης ως της νέας στρατηγικής για την καταπολέμηση της φτώχειας, καθώς και οι στόχοι κοινωνικής πολιτικής που εμπεριέχονται σε αυτή τη νέα στρατηγική που ονομάζεται «Σχέδιο Δράσης του Ευρωπαϊκού Πυλώνα των Κοινωνικών Δικαιωμάτων».This diplomatic paper examines the social phenomenon of poverty in the European Union, namely the legal actions adopted by the European Union in recent decades to deal with this complex phenomenon. The purpose of this paper is to try to present a change in the European Union's attitude that has occurred over the decades by an economic entity in an association that wants to showcase its social dimension and take action to cope with the social problems that are plaguing it, such as poverty and social exclusion. In this context it will be analyzed: The strategies and tools adopted by the European Union to support its social dimension, such as the introduction and functioning of the Open Method of Coordination, the European Semester as the governance framework, the adoption and structure of the European Pillar of Social Rights, the implementation of the Pillar in the context of the action plan as the new strategy for combating poverty, as well as the social policy objectives contained in this new strategy called the "European Pillar of Social Rights Action Plan.&quot

Unlike type 2 diabetes, type 1 does not interact with the codon 54 polymorphism of the fatty acid binding protein 2 gene

In type 2 diabetes, the threonine (Thr) for alanine (Ala) codon 54 polymorphism of the fatty acid binding protein 2 gene is associated with elevated fasting and postprandial triglycerides and dyslipidemia when compared with the wild type (Ala-54/Ala-54). To assess whether this is the case in patients with type 1 diabetes, who usually do not manifest the metabolic syndrome, we screened 181 patients with similar glycemic control as the type 2 patients. Thirty percent were heterozygous, and 9% were homozygous for the polymorphism. Mean (± SEM) fasting plasma triglyceride levels in patients with the wild type (n = 84), those heterozygous for Ala-54/Thr-54 (n = 44), and those homozygous for the Thr-54 (n = 13) were 1.0 ± 0.07, 1.1 ± 0.17, and 1.2 ± 0.23 mmol/liter, respectively. In addition, there were no differences in total, low-density lipoprotein, high-density lipoprotein, and non-high density lipoprotein cholesterol among the three groups. After a fat load, the postprandial area under the curve of triglyceride in plasma, chylomicrons, and very low-density lipoprotein were similar between the wild type (n = 18) and the Thr-54 homozygotes (n = 12). In conclusion, in contrast to type 2, type 1 diabetes does not interact with the codon 54 polymorphism of the fatty acid binding protein 2 gene to cause hypertriglyceridemiea/dyslipidemia. Insulin resistance could account possibly for this difference