Death related to aortic coarctation in a young female during sexual intercourse

Coarctation of the aorta (CA) is diagnosed mainly in pediatric patients, and therapy is conservative if asymptomatic, but surgical treatment is required if advanced arterial hypertension is present. Moderate to severe forms contraindicate any type of physical activity requiring cardiac effort. Here, we describe the first documented death of an apparently healthy 35-year-old woman because of cardiac tamponade by rupture of an aortic aneurysm, possibly related to congenital CA, prolonged use of oxymetazoline hydrochloride, and physical and/or emotional stress during sexual activity. Our patient was asymptomatic for classical CA symptoms. The patient's breathing difficulties likely in hindsight were due not so much to nasal congestion, but rather to an ineffective oxygenation of the blood from the abnormal heart. In an attempt to treat the "nasal disease," the patient ingested chronic and excessive doses of decongestants, aggravating her fatal disease. The danger of inhaling large doses of nasal decongestants without an appropriate medical indication is highlighted here.     

The People and Populism

“What is and what is defined as populism?” In response to this question the best political theories and philosophies have put forward many different answers, that are taken into account in this article. The article affirms the constitutive ambiguity of the concept of “populism” and its ability to unify very different issues. After analyzing some of the implications that populism entails in practice (in particular the political use of fear and the emphasis on the role of the citizens' anxieties because of migratory flows, the spiral of fear and insecurity triggered by terrorism, the role of religions as symbolic repertoires), the article stresses the link between populism and the end of the logic of the principle of representation, specific of the liberal and democratic theories. The emphasis on the role of the “people” in opposition to the political elites is also a feature of populism, analyzed by the author in this article. In conclusion, the author focuses on the legal field: some of the contemporary constitutional theories, in particular the so‐called “popular constitutionalism”, are discussed. These theories, while polemicizing with those authors who overestimate the role of the Supreme Court, reassess the function of the average citizen in the life of constitutional culture, with the intent of favouring greater political participation and strengthening democratic life.     

Reform: health care

The Italian National Health Service was established in 1978 as three-tier system, involving State, Regions, USLs (Unità sanitarie locali, Local Health Care Units). The division between the responsibility of determining the general features of health care policy and financing it, on one side (the State), and that of managing services, on the order side (Regions and USLs), was bound to lead to increasing levels of expenditure and large financial deficits. An important reform has been carried out over the last five years, aiming toward a more decentralized system, which, although still public, were based on competition among suppliers and free choice for consumers. We argue that although the reform seems to have been successful in containing public expenditure, it has left some important issues still unresolved: the relationship between patients' freedom of choice and competition among providers, and the definition of a model of rationing the bundle of health services financed by the public sector.     

Suicide by Self‐Administration of a Drug Mixture (Propofol,Midazolam, and Zolpidem) in an Anesthesiologist: The First Case Report in Italy

The authors report an unusual case of suicide of an anesthesiologist, in which the suicide manner and means depend upon the victim's occupation. This is the first case report published in Italy of a death involving propofol and other drugs. The anesthesiologist was found dead with an empty drip still inserted in the hand and another one near his body. Forensic and toxicological findings suggested that the cause of death was a respiratory depression due to a self‐administration of a rapidly infused lethal drug mixture. Analytical drug quantification was performed by gas chromatography‐mass spectrometry. Blood analysis revealed: zolpidem (0.86 μg/mL), propofol (0.30 μg/mL), midazolam (0.08 μg/mL), thiopental (0.03 μg/mL), and amitriptyline (0.07 μg/mL). Adipose tissue and hair analysis suggested a previous and repeated use of these drugs verifying the fact that in Italy recreational abuse of anesthetic and sedative agents in health care practitioners is becoming an increasing problem.     

Centre parties and anti‐system oppositions in polarised systems

This article seeks to show the connection between the ‘positive’ integration of anti‐system oppositions and governmental coalitional strategies in four European polarised democracies (the French Fourth Republic, the Weimar Republic, Finland and Italy). It tests the possibility of a stabilisation of some polarised systems (Finland and Italy) through the extension of co‐operation between anti‐system oppositions and centre parties in government. The aim of this research is therefore to locate some of the factors which can halt the ‘enfeeblement of the centre’ in polarised systems, namely through the ‘conversion’ of at least part of the anti‐system oppositions into loyal or semi‐loyal ones, and the extension of the centre area of the party system.     

Industrial concentration in Europe

The European Union has been trying to achieve its long-term goals through partnerships and cooperation with other like-minded global actors. Africa (through its regional institutional body, the African Union) has been the first and only multilateral entity with which the EU has forged a long-term partnership. Despite its rhetorical language, the Africa--EU Strategic Partnership is unlikely to upgrade the political and economic interaction between the two partners. In the past few years, serious rifts have grown between the EU and its African counterparts concerning trade agreements and development policies. Moreover, new actors have made significant inroads in Africa, providing an alternative to its long-standing dependence on Europe.     

China’s Structural Power and the Fate of the BCIM Economic Corridor

ABSTRACT

In 2013, China and India officially established an economic corridor (the Bangladesh–China–India–Myanmar Economic Corridor, BCIM-EC) that would cut across Myanmar and Bangladesh. But while the formal process of cooperation among the four countries is in place, many obstacles to its implementation remain at the international, national and local levels. Is meaningful collaboration possible within the BCIM-EC framework? In terms of two dimensions of structural power as conceptualised by Susan Strange, security and trade, China’s structural power in Myanmar is much stronger than India’s. It is therefore likely that this imbalance will prevent the BCIM-EC project, which currently appears to be overshadowed by China’s Belt and Road Initiative, from having a fruitful outcome.     

The gradual corporatization of transport infrastructure: The Danish case

The article introduces the theoretical perspective on gradual institutional change to the corporatization literature. This is achieved via a longitudinal case study on the institutionalization of the Danish state guarantee model (SGM) for transport infrastructure based on archival document studies of seven infrastructure projects and 31 interviews with elite actors and experts. The article explores with a detailed analysis how the gradual change mechanisms of layering, conversion and displacement coexist, are interrelated, and are coevolving over a long period. It contributes to the corporatization literature presenting the SGM as an alternative to public and private partnerships and government agencies.