Dialogue as Moral Paradigm: Paths Toward Intercultural Transformation

The Council of Europe’s 2008 White Paper on Intercultural Dialogue: ‘living together as equals in dignity’ points to the need for shared values upon which intercultural dialogue might rest. In order, however, to overcome the monologic separateness that threatens community, we must educate ourselves to recognize the dialogism of our humanity and to engage in deep encounters with others with a mature skepticism of all dogmatisms, including our own. In order to aid us in reaching the necessary insight, the author calls upon Bakhtin’s ideas of the dialogism of every utterance and of the unity and heteroglossia of language, Gadamer’s hermeneutical experience that shakes us loose from what we think we know, and Levinas’s description of that transcendent ideal of a dialogue beyond reciprocity. These perspectives break open our certainty that tribalism and individualism are fundamental, placing them instead as secondary phenomena that, though powerful, pronounce neither the initial nor the final word on our life together

Reflections and recommendations on the COVID-19 pandemic: Should hormone therapy be discontinued?

Since the COVID-19 pandemic outbreak, the extent of seriouscomplications and high rate of mortality has concerned all the healthauthorities worldwide. Death by COVID-19 is mainly due to acute re-spiratorydistresssyndrome(ARDS),althoughheartandmultipleorganfailure may contribute [1]. Underlying mechanisms are COVID-19-in-duced endothelial alteration, cytokine storm, inflammation, exudationin the lungs, and vessel occlusion.1. DifferencebetweensexesMortalitybyCOVID-19ishigherinmenthaninwomen.Amongtheadvocated reasons are a different exposure to risk factors such assmoking, reduced care of men about their health or different associa-tion with other morbidities. Nevertheless, a different expression ofACE2 may explain the different mortality between sexes. COVID-19disease progression is reduced by ACE2 enzyme expression in en-dothelial cells mainly at the lung and heart, where it exerts vasodi-lating, anti-inflammatory and anticoagulant effects [2]. ACE2 is codedby the X chromosome, of which men have only one, and ACE2 ex-pression in endothelial cells is stimulated by estrogens [2]. The possi-bility that thismechanisms accountsfor the lowermortalityof womenvs. men (Yi et al.) is sustained by the recent evidence that reducedmortality (−72 %) of fertile women vs. men is lost, at least in part, inthe postmenopausal years (−49.6 %) [3].2. HormonetherapyThese data lead to speculation that hormone therapy or even po-tentiating estrogen stimulus by exogenous estrogens may antagonizethe deadly progression of the disease. On the other hand, exogenousestrogens may increase coagulating factors and the risk of throm-boembolic events with a potential consequent increase in mortality.Hospitalized individuals with very severe COVID-19 disease have anactivated coagulation defined by high levels of D-dimers, products offibrin degradation, and when D-dimer levels are very high, antic-oagulants like heparin may reduce mortality [4]. In order to decreasethe risk of thromboembolic events a recent publication has re-commended that peri- and post-menopausal women immediatelywithdraw from exogenous hormone administration after becoming in-fected by COVID-19 [5]. This position stimulates some considerations.1) Thrombophilic states are not among the comorbidities that ac-celerate COVID-19 disease progression. To date, there is no reportdocumenting that the most thrombophilic state in woman life, i.e.pregnancy,orevenhormonalcontraceptiveuse[6],isassociatedwithaworst prognosis of COVID-19 infection. 2) Locally formed thrombi,consequenttomassiveendothelialdisruptionandlocalactivationoftheextrinsic coagulation cascade, rather than cloth emboli, appear to oc-cludelungvesselsofCOVID-19-infectedindividualsinthelaststageofdisease[4].Indeed,theevidencethatmanywomenwithoccludedlungvessels lack peripheral vein thrombosis challenges the theory of amassively increased thrombophilic condition [4]. Of the Virchowtriadexplainingbloodclotformation,i.e.increasedcoagulation,bloodstasisand altered endothelium, it is the third component that is highly pre-valent in COVID-19 individuals, the contribution of increased coagu-lation being unknown and probably negligible [4]. 3) The dose of he-parinusedinCOVID-19-infectedindividuals(80−100mg)exceedstheprophylacticdoseforthrombophilicstates.4)Aputativeincreasedriskof venous thrombosis due to increased synthesis of coagulation factorsis mainlylimited tothefirsttwo years oforal estrogenadministration,and up to now no study has reported a thrombophilic effect of trans-dermal estrogens [7]. 5) Perimenopausal women requiring hormonalcontraception are usually in their late forties and postmenopausalwomen start their hormone therapy for symptoms before 60 years ofage. In these years, mortality from COVID-19 is below 1 % [3], andthere is no report that it is higher in women on hormones.3. ConclusionsAt first sight, indications for COVID-19-positive individuals towithdraw from hormone therapy or oral contraceptives may seem awise recommendation, but it is not based on real data. It takes intoconsideration only one side of the coin, the procoagulant activity ofexogenousoralestrogens.ThiseffectforCOVID-19patientsislikelytheleast important. In these individuals, increased coagulation is con-sequent to massive endothelial disruption and to the activation of theextrinsic coagulation cascade, with no evidence that an increase incoagulating factors plays any role [4]. By contrast, the advice towithdraw from estrogens misses a consideration of the main effect ofestrogens, i.e. their ability to stimulate ACE2 enzyme expression, acritical factor in reducing mortality from COVID-19 [2].4. RecommendationsOn these bases, we suggest that advice for COVID-19-infectedwomen should be:a Hormone therapy or hormonal contraceptives [6] should be con-tinued, unless the woman is severely ill, a condition in which hor-monalbalanceisprobablynotsocrucial.Intheotherconditions,thepossibility that hormone withdrawal may accelerate COVID-19https://doi.org/10.1016/j.maturitas.2020.05.022Received 16 May 2020DOI of original article:https://doi.org/10.1016/j.maturitas.2020.05.021Maturitas 138 (2020) 76–770378-5122/ © 2020 Elsevier B.V. All rights reserved.

EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2013 . Scientific opinion on Dietary Reference Values for fluoride

Following a request from the European Commission, the Panel on Dietetic Products, Nutrition and Allergies (NDA) derived Dietary Reference Values (DRVs) for fluoride, which are provided as Adequate Intake (AI) from all sources, including non-dietary sources. Fluoride is not an essential nutrient. Therefore, no Average Requirement for the performance of essential physiological functions can be defined. Nevertheless, the Panel considered that the setting of an AI is appropriate because of the beneficial effects of dietary fluoride on prevention of dental caries. The AI is based on epidemiological studies (performed before the 1970s) showing an inverse relationship between the fluoride concentration of water and caries prevalence. As the basis for defining the AI, estimates of mean fluoride intakes of children via diet and drinking water with fluoride concentrations at which the caries preventive effect approached its maximum whilst the risk of dental fluorosis approached its minimum were chosen. Except for one confirmatory longitudinal study in US children, more recent studies were not taken into account as they did not provide information on total dietary fluoride intake, were potentially confounded by the use of fluoride-containing dental hygiene products, and did not permit a conclusion to be drawn on a dose-response relationship between fluoride intake and caries risk. The AI of fluoride from all sources (including non-dietary sources) is 0.05 mg/kg body weight per day for both children and adults, including pregnant and lactating women. For pregnant and lactating women, the AI is based on the body weight before pregnancy and lactation. Reliable and representative data on the total fluoride intake of the European population are not available

On the conservation of the slow conformational dynamics within the amino acid kinase family: NAGK the paradigm

N-Acetyl-L-Glutamate Kinase (NAGK) is the structural paradigm for examining the catalytic mechanisms and dynamics of amino acid kinase family members. Given that the slow conformational dynamics of the NAGK (at the microseconds time scale or slower) may be rate-limiting, it is of importance to assess the mechanisms of the most cooperative modes of motion intrinsically accessible to this enzyme. Here, we present the results from normal mode analysis using an elastic network model representation, which shows that the conformational mechanisms for substrate binding by NAGK strongly correlate with the intrinsic dynamics of the enzyme in the unbound form. We further analyzed the potential mechanisms of allosteric signalling within NAGK using a Markov model for network communication. Comparative analysis of the dynamics of family members strongly suggests that the low-frequency modes of motion and the associated intramolecular couplings that establish signal transduction are highly conserved among family members, in support of the paradigm sequence→structure→dynamics→function © 2010 Marcos et al

Valuation of ecosystem services to inform management of multiple-use landscapes

Public agencies worldwide are increasingly adopting an ecosystem service framework to manage lands serving multiple uses. Yet, reliable, practical, and well-tailored methods remain a major limitation in moving from conceptual to actionable approaches. Together with one of the largest federal land managing agencies, we co-develop and co-demonstrate an ecosystem services approach tailored to specific decisions, through a process with potentially widespread relevance. With the U.S. Department of Defense (DoD), we focus on balancing military training with biodiversity and resource conservation under both budgetary and land-use pressures at a representative installation. In an iterative process of co-design and application, we define, map, and quantify multiple ecosystem services under realistic management options. Resource management budget emerges as a major determinant of the degree to which managers can sustain both necessary training environments – a DoD-specific ecosystem service – and a prairie ecosystem with species of conservation concern. We also found clear tradeoffs between training intensity and forest-related services. Our co-developed approach brings otherwise hidden values and tradeoffs to the fore in a balanced way that can help public agencies safeguard priority services under potentially conflicting uses and budget limitations

Association of asthma with extra-respiratory symptoms in schoolchildren: two cross-sectional studies 6 years apart

Epidemiological information on symptoms affecting extra-respiratory organs and apparatuses in asthmatic children is scarce. The aim of this study therefore was to evaluate, at a population level, if and what extra-respiratory symptoms are associated with asthma. Two questionnaire-based, cross-sectional surveys were carried out on 1,262 students (651 males; mean age 9.57 years, age-range 6-14 years) in 1992 and on 1,210 students (639 males; mean age 9.02 years, age-range 6-14 years) in 1998, from two elementary and two junior high schools in Rome, Italy. Questionnaires included queries about asthma and its risk factors and extra-respiratory symptoms (headache, restlessness, sleep disturbances, urticaria, itching, and abdominal pain). Of responders, 11.9% (279/2,342) had a history of asthma. After adjustment for gender, family history of atopic disease, low birth weight, early respiratory problems, and damp house, asthma was significantly associated with recurrent abdominal pain (odds ratio [OR] 1.90; 95% confidence interval [CI]: 1.04, 3.16), itching (OR 3.15; 95% CI: 1.75, 5.68), and urticaria (OR 2.52; 95% CI: 1.02, 6.20). Asthma was reported by 10.2% (201/1,962) of children unaffected by this triad, by 20.1% (56/279; OR 2.20) with one of the symptoms, and by 31.6% (12/38; OR 4.04) with two or more symptoms. An emerging characteristic of pediatric asthma in our setting appears to be its association with certain extra-respiratory symptoms (abdominal pain, itching, and urticaria). A global, internistic approach to asthmatic children is increasingly required both in the clinical setting and in future epidemiological studies

Optimal First Trimester Preeclampsia Prediction: a Comparison of Multimarker Algorithm, Risk Profiles and Their Sequential Application

OBJECTIVE: To compare performance of multimarker algorithm, risk profiles and their sequential application in prediction of preeclampsia and determining potential intervention targets. STUDY DESIGN: Maternal characteristics, ultrasound variables and serum biomarkers were collected prospectively at first trimester. Univariate analysis identified preeclampsia associated variables followed by logistic regression analysis to determine the prediction rule. Combined characteristics of the cardiovascular, metabolic and the personal risk factors were compared to the multimarker algorithm and the sequential application of both methods. RESULTS: Out of 2433 women, 108 developed preeclampsia (4.4%). Probability scores considering nulliparity, prior preeclampsia, body mass index, diastolic blood pressure and placental growth factor had an area under the receiver operating characteristic curve 0.784 (95% CI = 0.721-0.847). While the multimarker algorithm had the lowest false negative rate, sequential application of cardiovascular and metabolic risk profiles in screen positives reduced false positives by 26% and identified blood pressure and metabolic risk in 49/54 (91%) women with subsequent preeclampsia as treatable risk factors. CONCLUSION: Sequential application of a multimarker algorithm followed by determination of treatable risk factors in screen positive women is the optimal approach for first trimester preeclampsia prediction and identification of women that may benefit from targeted metabolic or cardiovascular treatmentinfo:eu-repo/semantics/publishedVersio

TRENats

Procedimiento restringido y concurso de proyectos con intervención de jurado, de los servicios para la redacción de los proyectos de Urbanización y Construcción de las fases 1ª, 2ª Y 3ª del Parque Lineal de la Sagrera – Sant Andreu en BarcelonaTercer premiAward-winningPostprint (published version