The welfare state and new challenge from the back door

1980s in Germany, Britain, France and Italy suggests a convergent and consistent process of homogenisation driven chiefly by institutional mimetic isomorphism. This new 'organisational settlement' is increasingly shaped by the structural autonomisation of individual service delivery units. This paper argues that, when organisational autonomy becomes normatively sanctioned, that this increases the likelihood of its adoption, even in the face of different institutional conditions and welfare regimes. Hence, the paper is foremost concerned with explaining similarities and decreasing variance across countries and across sectors, and with accounting for the main driver of this homogenisation process. Why would different organisational fields across countries and welfare regimes adopt similar structures, in light of inconclusive evidence of economic efficiency gains? The convergence of the organisational settlement of the welfare delivery state is not only driven by economic globalisation or efficiency linked to performance, but primarily by the political demand to find new sources of legitimation in an age of increasing displacement of political authority to managers. The paper is structured in three main parts. First, it revisits the theory of organisational isomorphism by its application to the new patterns of change of welfare delivery. Secondly, it discusses the reform trajectories of autonomisation in schooling and hospital care in Britain, in comparative terms with France and Italy. Thirdly, it concentrates on Germany and it establishes empirically how this case does no longer fit the characterisation of 'immobilisme', especially in the health care sector. Lastly, the wider implications of organisational homogenisation for the TRUDI constellation are discussed. --

The modernisation of the welfare state in Italy: dynamic conservatism and health care reform, 1992 to 2003

An institutional pattern of administrative inertia and resistance has traditionally characterised the reform of the Italian State. It is widely held that the historical development of the state has contributed to this immobilisme. The effect of the Italian system of party government on bureaucratic autonomy is also blamed for the failure (until recently) of attempts to reform the Italian state. However, definite changes affecting welfare administration in Italy reveal a radical departure from the status quo, as a result of particular reform mechanisms and the strategies of elites in handling blockages during the process of legislative implementation of delegating laws designed to introduce ambitious reform programmes. 'Dynamic conservatism' is the novel theoretical approach elaborated here to study policy change in such stalled administrative systems, and it offers an explanation of how it becomes possible to break historically determined immobilisme. The case of healthcare reforms in Italy in the 1990s has marked an impressive departure from traditional administrative practice. The thesis argues that two key innovations have been accomplished: first, the emergence of public managers charged with extensive policy leadership at the top of regional welfare administration, increasingly legitimised by expertise and technical knowledge rather than political entrepreneurialism; secondly, the reconfiguration of traditional centre- periphery relations, triggered by the territorial disturbance caused by regionalisation. The consolidation of policy change, underpinned by the paradigm of the entrepreneurial state, was most noticeable at regional level. Such change was achieved, however, only by handling beforehand two major blockages: first, the opposition of political parties during the parliamentary process to the reconfiguration of the relationship between politics and administration; secondly, the adversarial response of interest groups to policy change

Nanoroughness, Surface Chemistry and Drug Delivery Control by Atmospheric Plasma Jet on Implantable Devices

Implantable devices need specific tailored surface morphologies and chemistries to interact with the living systems or to actively induce a biological response also by the release of drugs or proteins. These customised requirements foster technologies that can be implemented in additive manufacturing systems. Here we present a novel approach based on spraying processes that allows to control separately topographic features in the submicron range ( 3d 60 nm - 2 \ub5m), ammine or carboxylic chemistry and fluorophore release even on temperature sensitive biodegradable polymers such as polycaprolactone (PCL). We developed a two-steps process with a first deposition of 220 nm silica and poly(lactic-co-glycolide) (PLGA) fluorescent nanoparticles by aerosol followed by the deposition of a fixing layer by atmospheric pressure plasma jet (APPJ). The nanoparticles can be used to create the nano-roughness and to include active molecule release, while the capping layer ensures stability and the chemical functionalities. The process is enabled by a novel APPJ which allows deposition rates of 10 - 20 nm\ub7s-1 at temperatures lower than 50 \ub0C using argon as process gas. This approach was assessed on titanium alloys for dental implants and on PCL films. The surfaces were characterized by FT-IR, AFM and SEM. Titanium alloys were tested with pre-osteoblasts murine cells line, while PCL film with fibroblasts. Cell behaviour was evaluated by viability and adhesion assays, protein adsorption, cell proliferation, focal adhesion formation and SEM. The release of a fluorophore molecule was assessed in the cell growing media, simulating a drug release. Osteoblast adhesion on the plasma treated materials increased by 20% with respect to commercial titanium alloys implants. Fibroblast adhesion increased by a 100% compared to smooth PCL substrate. The release of the fluorophore by the dissolution of the PLGA nanoparticles was verified and the integrity of the encapsulated drug model confirmed

ICSBP Is Essential for the Development of Mouse Type I Interferon-producing Cells and for the Generation and Activation of CD8α+ Dendritic Cells

Interferon (IFN) consensus sequence-binding protein (ICSBP) is a transcription factor playing a critical role in the regulation of lineage commitment, especially in myeloid cell differentiation. In this study, we have characterized the phenotype and activation pattern of subsets of dendritic cells (DCs) in ICSBP−/− mice. Remarkably, the recently identified mouse IFN-producing cells (mIPCs) were absent in all lymphoid organs from ICSBP−/− mice, as revealed by lack of CD11clowB220+Ly6C+CD11b− cells. In parallel, CD11c+ cells isolated from ICSBP−/− spleens were unable to produce type I IFNs in response to viral stimulation. ICSBP−/− mice also displayed a marked reduction of the DC subset expressing the CD8α marker (CD8α+ DCs) in spleen, lymph nodes, and thymus. Moreover, ICSBP−/− CD8α+ DCs exhibited a markedly impaired phenotype when compared with WT DCs. They expressed very low levels of costimulatory molecules (intercellular adhesion molecule [ICAM]-1, CD40, CD80, CD86) and of the T cell area-homing chemokine receptor CCR7, whereas they showed higher levels of CCR2 and CCR6, as revealed by reverse transcription PCR. In addition, these cells were unable to undergo full phenotypic activation upon in vitro culture in presence of maturation stimuli such as lipopolysaccharide or poly (I:C), which paralleled with lack of Toll-like receptor (TLR)3 mRNA expression. Finally, cytokine expression pattern was also altered in ICSBP−/− DCs, as they did not express interleukin (IL)-12p40 or IL-15, but they displayed detectable IL-4 mRNA levels. On the whole, these results indicate that ICSBP is a crucial factor in the regulation of two possibly linked processes: (a) the development and activity of mIPCs, whose lack in ICSBP−/− mice may explain their high susceptibility to virus infections; (b) the generation and activation of CD8α+ DCs, whose impairment in ICSBP−/− mice can be responsible for the defective generation of a Th1 type of immune response

Obsessive-compulsive disorder and related disorders: a comprehensive survey

Our aim was to present a comprehensive, updated survey on obsessive-compulsive disorder (OCD) and obsessive-compulsive related disorders (OCRDs) and their clinical management via literature review, critical analysis and synthesis

COPD: adherence to therapy

Adherence to medical therapies is a growing issue, so much so that the World Health Organization defined it as "a new pharmacological problem". The main factors affecting compliance are: frequency of administration, rapid onset of action, role of device. The most severe consequence of non-adherence is the increased risk of poor clinical outcome, associated with worsening of the quality of life and increase in health-care expenditure. It appears crucial to identify those COPD patients who are "poorly or not at all compliant with their treatment". In order to evaluate adherence to the medical therapy, several methods were proposed, the most effective of which turned out to be self-reports, i.e. simple, brief questionnaires (e.g. Morisky test). To increase the likelihood of quickly identifying non-compliant patients, it may be useful to administer a simple questionnaire to naïve subjects (for example, in the waiting room before an examination) including six specific items allowing to identify the patient's key characteristics. Depending on the answers, patients who do not comply with their pharmacological treatment may be classified as belonging to 6 phenotypes. For patients who are already under treatment it might be useful to administer another short questionnaire during follow up examination. Once the risk of non-compliance is identified, four possible types of measures can be taken: prescription-related, educational, behavioral and complex combined measures (combination of two or more actions). Therefore, while it is clear that adherence in COPD is a critical issue, it is also obvious that raising awareness on the disease and improving cooperation among specialists, general practitioners, health-care professionals, and patients is the starting point at which this evolution should immediately begin. Each medication is able to foster good compliance with the therapy, and consequently to maximize the efficacy, by virtue of its specific inhaler and its own active ingredient

Geomorphology of Naples and the Campi Flegrei: human and natural landscapes in a restless land

Naples and its surroundings are a very young landscape, originated from 40 ka in response to strong and explosive volcanic processes, which created the Campi Flegrei, one of the largest volcanic fields of the world. Despite the repeated and continuous volcanic activity, this territory was selected for human settlements since Neolithic times and hosted some of the most important Greek and Roman towns in the Mediterranean area (e.g., Cuma, Parthenope, Neapolis, Baia and Puteoli). Geoarcheological data and historical chronicles testify to human coexistence with eruptions, bradyseismic ground motions, coastline changes, floods and landslides. With the aim of describing the geomorphological evolution of this area to a wide audience, including also non-experts, we constructed a synthetic geomorphological map of the area and sketches that synthesise the main stages of the geomorphological evolution of the historical centre of Naples and the coastal belt of the Gulf of Pozzuoli during the last millennia

Role of myristoylation in modulating PCaP1 interaction with calmodulin

Plasma membrane-associated Cation-binding Protein 1 (PCaP1) belongs to the plant-unique DREPP protein family with largely unknown biological functions but ascertained roles in plant development and calcium (Ca2+) signaling. PCaP1 is anchored to the plasma membrane via N-myristoylation and a polybasic cluster, and its N-terminal region can bind Ca2+/calmodulin (CaM). However, the molecular determinants of PCaP1-Ca2+-CaM interaction and the functional impact of myristoylation in the complex formation and Ca2+ sensitivity of CaM remained to be elucidated. Herein, we investigated the direct interaction between Arabidopsis PCaP1 (AtPCaP1) and CaM1 (AtCaM1) using both myristoylated and non-myristoylated peptides corresponding to the N-terminal region of AtPCaP1. ITC analysis showed that AtCaM1 forms a high affinity 1:1 complex with AtPCaP1 peptides and the interaction is strictly Ca2+-dependent. Spectroscopic and kinetic Ca2+ binding studies showed that the myristoylated peptide dramatically increased the Ca2+-binding affinity of AtCaM1 and slowed the Ca2+ dissociation rates from both the C- and N-lobes, thus suggesting that the myristoylation modulates the mechanism of AtPCaP1 recognition by AtCaM1. Furthermore, NMR and CD spectroscopy revealed that the structure of both the N- and C-lobes of Ca2+-AtCaM1 changes markedly in the presence of the myristoylated AtPCaP1 peptide, which assumes a helical structure in the final complex. Overall, our results indicate that AtPCaP1 biological function is strictly related to the presence of multiple ligands, i.e., the myristoyl moiety, Ca2+ ions and AtCaM1 and only a full characterization of their equilibria will allow for a complete molecular understanding of the putative role of PCaP1 as signal protein

Monitoring of hadrontherapy treatments by means of charged particle detection

The interaction of the incoming beam radiation with the patient body in hadrontherapy treatments produces secondary charged and neutral particles, whose detection can be used for monitoring purposes and to perform an on-line check of beam particle range. In the context of ion-therapy with active scanning, charged particles are potentially attractive since they can be easily tracked with a high efficiency, in presence of a relatively low background contamination. In order to verify the possibility of exploiting this approach for in-beam monitoring in ion-therapy, and to guide the design of specific detectors, both simulations and experimental tests are being performed with ion beams impinging on simple homogeneous tissue-like targets (PMMA). From these studies, a resolution of the order of few millimeters on the single track has been proven to be sufficient to exploit charged particle tracking for monitoring purposes, preserving the precision achievable on longitudinal shape. The results obtained so far show that the measurement of charged particles can be successfully implemented in a technology capable of monitoring both the dose profile and the position of the Bragg peak inside the target and finally lead to the design of a novel profile detector. Crucial aspects to be considered are the detector positioning, to be optimized in order to maximize the available statistics, and the capability of accounting for the multiple scattering interactions undergone by the charged fragments along their exit path from the patient body. The experimental results collected up to now are also valuable for the validation of Monte Carlo simulation software tools and their implementation in Treatment Planning Software packages