Month: March 2014

Dislike of ambulances

Ambulances are great, helpful when in need,Life Saving.

Very useful, we can’t do without them
I live in a long and winding and sometimes windy road, with my own problems at this moment
Ambulance passed 5 minutes ago Siren going, Lights Flashing , no traffic, at about 15km an hour and i can still hear it.
Is it an Emergency ?
Maybe the guys who drive the ambulance like flashing lights and sirens ?.
Maybe the patient likes these things ?.
I’m confused, don’t know, I don’t like it.
Am I all l  fucked Up ?

Tradizione gaelico – Alcol Uomini e Donne

Originale Gaelic Tradition, Gender and Alcohol in Inglese The Virtual Gael 

La tradizione è una spada a doppio taglio. Può essere una fonte di comfort e stabilità, che collega gli individui a una comunità più ampia di sostegno e senso di continuità nei momenti di ansia e di sconvolgimento. Essa può anche essere usato come una spiegazione razionale per radicare i privilegi di un gruppo contro gli interessi di un altro e perpetuare l’intolleranza e le disuguaglianze. La tradizione non è una forza impersonale esterna causando certe cose accadano: si tratta di una questione dell’agire umano. Gli individui – soprattutto quelli con il potere e l’influenza – attingono alla tradizione selettivo e creativo per giustificare qualche scelta, e spetta alla comunità decidere se tale utilizzo è giustificabile o meno.

Negli ultimi anni, gli scienziati hanno dimostrato che molti membri del mondo animale intenzionalmente ingerire sostanze che modificano i loro stati di coscienza. Forse il peso della coscienza è così alta che tutti abbiamo bisogno in qualche modo di fuggire dalla realtà periodicamente. Non voglio speculare qualsiasi s’affacciava sulle ragioni, ma è interessante che fino droghe sintetiche sono state prodotte nella metà del 20 ° secolo, tutte le sostanze che sono state “abusate” – l’alcool, il tabacco, la marijuana, la psilocibina, ecc – vengono da culture che hanno avuto vincoli sociali naturali che limitavano il loro impatto: ad esempio, sono stati limitati a uso rituale, alle forniture limitate di disponibilità, per l’impatto che potrebbero avere sulla autosufficienza, ecc Molti di questi fattori limitanti sono scomparsi, e forse la capacità delle persone di autoregolarsi non ha tenuto il passo con questi cambiamenti.

L’alcol in particolare ha una lunga storia nella storia gaelico per diversi scopi e contesti, e ho esplorato alcuni di questi problemi in due libri precedenti (A Handbook of the Scottish Gaelic World and Warriors of the Word ), così come in un libro di prossima pubblicazione ( The Naughty Little Book of gaelico ). Ecco un breve riassunto, in primo luogo, offrendo è un atto di generosità, l’ospitalità e la coesione sociale. In secondo luogo, si trattava di un mezzo di commemorare e anche comunicare con i morti ancestrale – il moderno “brindisi” è una traccia di questo. In terzo luogo, si trattava di un mezzo di invocare uno stato alterato di coscienza, un “alto” che si è intensificata la piacevole convivialità sociale delle occasioni in cui è stato condiviso tra i padroni di casa e gli ospiti. Infine, è previsto un breve colpo di calore in un clima freddo.

E ‘naturale e inevitabile, quindi, che la Scozia dovrebbe essere una terra di alcolisti rampanti e che i figli e le figlie della Scozia devono avere profili simili in cui l’alcol è interessato? La tradizione gaelica approva e giustifica una elevata incidenza di uso di alcol in ogni comunità di Highlanders o loro discendenti?

Io credo di no.

L’abuso di sostanze è una questione complessa, e sarebbe imprudente attribuire ad ogni singola causa o fattore. Ci sono diversi punti di ingresso e di molti fattori di auto-rinforzo, ma in questo blog mi piacerebbe dimostrare brevemente che l’idea che dovremmo mettere in discussione l’ipotesi che la tradizione gaelica approva l’indulgenza (over-) di alcool, cercando in qualche letteratura Nova Scotia, e poi ti guardo alcune recenti ricerche da Nova Scotia sulle conseguenze e i costi di questa “tradizione”.

L’evidenza nel Canto-Poesia gaelico

Una delle fonti più abbondanti e importanti informazioni che abbiamo sulle comunità gaeliche e persone è la canzone-poesia. Queste composizioni riflettono la vita quotidiana e le preoccupazioni delle comunità gaeliche, ma riflettono anche le personalità e le aspirazioni dei loro autori specifici. Canzone poesia era una presenza costante nella vita dei gaelici fino a poco e non può non aver avuto un’influenza pervasiva sui propri valori, percezioni e visione del mondo, proprio come la televisione ha avuto un’influenza pervasiva sulla vita di adulti nordamericani (e il Internet sta avendo sui loro figli).

Ogni volta che una controversia sorta che aveva bisogno di un consenso comune, un poeta avrebbe messo in forma   poetica un lato di un argomento del dibattito . La canzone-poesia potrebbe essere eseguita e un altro poeta potrebbe rispondere con il suo proprio caso in versi. Uno dei formati preferiti di queste poesie di persuasione è la poesia “dialogo”, che si propone di esprimere entrambi i lati di una controversia , ma, generalmente , il poeta di solito nel composizione della poesia esponeva ogni lato con attenzione in modo che era chiaro chi era il vincitore.

Numerose canzoni-poesie segnano dibattiti su prodotti o prassi recentemente introdotte per le comunità gaelico: tè, traghetti domenicale, organi in chiesa, anche cornamuse (nel 17 ° secolo)! Esplorando qualora l’oggetto o la pratica sono accettate nella vita della comunità? Il Perché o il perché no? Potrebbe essere modificato per soddisfare i valori comuni e l’estetica, o era semplicemente troppo offensivo per la sensibilità nativa? Il Temperance Movement ha avuto un enorme impatto su molte comunità differenti e aveva dimensioni sociali, religiosi e morali, quindi non è una sorpresa che è stato oggetto di numerose canzoni-poesie gaelico.

Prima di procedere, tuttavia, va notato che il canzone-poesia gaelico lamentarsi degli eccessi del bere pre-data del moderno movimento Termperance da generazioni. (Ho già pubblicato alcune e altri  apparirò in The Naughty Little Book of Gaelic .) Questo conferma ancora una volta che le norme sociali e le aspettative sono state codificate non solo in versi ma discusso anche lì.

Secondo Dunbar (2008: 81), la prima società di temperanza in gaelico Nova Scotia è stata fondata nel Pictou County nel 1828, e in poco tempo, i capi religiosi (in entrambe le comunità cattoliche e protestanti) esercitavo pressioni sul loro congregazioni a firmare giuramenti di astinenza da alcol. Alcuni membri importanti della comunità non tengono ai loro giuramenti a lungo, e anche questo ha attirato l’attenzione di cantastorie  gaelico.

L’intero episodio è stato oggetto di diverse canzoni-poesie di alcuni tra i maggiori poeti del giorno. Tra le canzoni di due dei poeti (Am Bard MacGillean and Domhnall “Gobha” MacGilleFhaolain), Dunbar (2008: 81-2)) scrive che essi “hanno visto tali divieti sul bere come un po ‘non-gaelico […]”, che rappresentano invece l’alcol come “un aspetto centrale della cultura gaelica, al contrario, promotori della temperanza sono ritratti come estranei, e per deduzione, promotori di una cultura aliena.”

Mentre questo può essere l’idea che questi poeti stanno esprimendo nella loro poesia, non dobbiamo confondere le strategie retoriche di questi particolari autori di sesso maschile – come si stanno giustificando le proprie agende – con le realtà sociali. Molti altri poeti e poesie mostrano una diversa angolazione in materia. Una poesia di Ailean “The Ridge” MacDhomhnaill della stessa epoca (Rankin 2004: 142-5) è in forma di un dibattito – o una partita di rimprovero – tra moglie e marito, con la moglie che lo rimprovera per i costi eccessivi del suo bere . Sua moglie era una Highlander pure, quindi questo non era un “estraneo ad imporre una cultura aliena.”

In realtà, ci sono molti altri poemi gaelici che verificano l’idea che, proprio come oggi, le donne portavano il peso del bere eccessivo degli uomini ed erano critiche dei suoi effetti negativi. Un altro dei maggiori poeti dell’epoca, Iain MacGilleBhràth (Iain am Pìobaire), composto una canzone intitolata Gearan Bean un’aria Amadain un Fear “La lamentela della moglie di un marito pazzo ” (stampato in Mac-Talla 25 agosto 1894). La canzone rappresenta il poeta tornando a casa da una serata in baldoria, sorpresa in entrata dalla moglie arrabbiata . Lei enumera i costi del bere e anche se il marito è dato una strofa della poesia per cercare di contenere il suo rimprovero al centro della composizione, si è permesso di continuare e avere l’ultima parola. Lei non insiste che lui desistere del tutto, ma di scegliere i suoi compagni con saggezza ed esercitare moderazione.

Un’altra canzone anti-alcolismo è apparso in Mac-Talla (25 gennaio 1901), questa volta da una donna (Barbara Friseal), intitolato Òran Connsachaidh Eadar Paura agus Bean mu’n OL “Una canzone di discussione tra marito e moglie sul bere. “Come suggerisce il titolo, è anche nella struttura di un dialogo e, come è stato scritto da una donna, è poco sorprendente che lei ottiene la prima e l’ultima parola. Anche se il marito insiste sul fatto che egli  beve sempre con un brindisi in suo onore, lei lo rimprovera per i suoi eccessi e le richieste che riformare se stesso.

In queste canzoni, e altri come loro, le donne – proprio come Gàidhealach “gaelico”, come i loro mariti ubriachi – affermano il loro valore e cercano di intervenire nei comportamenti eccessivi dei loro partner. Anche se le donne non gode dello stesso status sociale degli uomini nella società gaelico, o di avere le stesse opportunità di occupare ruoli ufficiali di autorità, abbastanza della loro capacità nelle istituzioni “informali”, come la casa, si riflette nella poesia gaelica per dare voce alle loro prospettive su questioni sociali complesse come questa e ci dovrebbero incoraggiare a pensare al di là della retorica di “pochi grandi uomini.”

Gàidhealach non Gòrach?

La tradizione può suggerire norme e gli standard di offerta (sempre come uno spettro di scelte multiple), ma spetta a noi decidere quale delle tante opzioni soddisfare i nostri interessi meglio. Esiste la tradizione di servire a noi come comunità, individualmente e collettivamente, per non costringerci in una camicia di forza. Molti gaelici hanno riconosciuto in passato. Ad esempio, Seumas MacNeill, redattore del periodico gaelico An Solus-Iùil (stampato a Sydney, Cape Breton), scrive nel numero di novembre 1925, ” Tha caochladh chleachdaidhean aig treubhan una t-saoghail, CUID un tha feumail Agus CUID nach Eil “(” I popoli del mondo hanno una varietà di costumi, alcuni dei quali sono utili e alcuni dei quali non lo sono. “) Questi scrittori gaelici erano molto capaci e disposti a criticare il comportamento e la tradizione quando ritenuto necessario.

In passato, il processo di impostazione di norme e valori sociali, e rispondere alle innovazioni esterne, è stato negoziato all’interno delle comunità gaeliche, in particolare con i meccanismi sociali, come la Ceilidh, con i poeti e gli anziani che fungono da portavoce e sostenitori. Al giorno d’oggi, l’adesione comunale è rotto, l’autorità di moderazione anziani è priva di senso, e sono le narrazioni esterne del mondo anglofono tradizionale di avere maggior peso e prestigio rispetto a quelli ereditati dal passato.

Una delle carenze della sanità moderna – sia di salute fisica e mentale – è che i pazienti siano esaminati e trattati come individui, piuttosto che come membri di una comunità il cui benessere è influenzato da grandi dinamiche sociali. Noi non siamo solo individui, ma i membri dei collettivi, e quando questi collettivi sono dominati da narrazioni di inferiorità, perdita e inadeguatezza, le persone soffrire così, o cerchiamo modi per fuggire. Questo, più di ogni altra cosa, credo, spiega l’alta incidenza di alcolismo che esiste a volte in comunità gaeliche.

Ho vissuto in Nova Scotia negli ultimi cinque anni. Sulle targhe auto della provincia si leggi ” Ocean Playground del Canada “, che ho interpretato come una dichiarazione triste che esiste solo per servire le fantasie e di desideri adempimenti dei canadesi altrove. E ‘il più rurale di tutte le province canadesi e l’unico con un spopolamento. Esso contiene anche le ultime vestigia delle comunità gaelico in Nord America. Un rapporto è stato pubblicato nel novembre 2011 dal titolo In Our Words: What Alcohol Use Looks Like In Our Towns,, ed è una lettura che fa riflettere. Ecco alcuni estratti suggestive che descrivono particolari locali e alcuni modelli generali (che non può, ovviamente, essere attribuiti interamente a gaelici):

Consumo pro capite di alcol in Nova Scotia è aumentato del 9,5% negli ultimi 10 anni. […] gli uomini e le donne Nova Scotian costantemente bere più pesantemente rispetto ai loro omologhi canadesi. […] Dalla violenza domestica e sessuale di aggressione, danni alla proprietà, atti di vandalismo, rumori e disturbi, informatori  in tutte e tre le città ci ha detto che alcol produce crimine. La polizia di Bridgewater e Antigonish attribuiti fino a tre quarti dei crimini dovuta al alcol. […] I nostri informatori hanno descritto una serie di esperienze personali  e costi individui a causa di alcol, tra cui potenziale perso, maggiore impulsività, gravidanze indesiderate, sesso a rischio, e l’incremento di  spesaper alcol  del  reddito familiare. Abbiamo anche sentito preoccupazioni per l’impatto dell’alcol sulla depressione, la rabbia e la salute mentale in generale.

Questo non è indice di benessere e di auto-interesse, ma sintomatico di problemi più profondi che devono ancora essere apertamente riconosciuto e risolto. La tradizione gaelica non condona la violenza auto-inflitta o abuso di altri, ma condivide buona salute, autocontrollo e l’autostima. E ‘difficile immaginare come le comunità autosufficienti in un ambiente che non perdona avrebbero potuto sopravvivere altrimenti.

Post Scritum

Sto aggiungendo una postilla dopo una risposta dal mio amico e collega Robert Dunbar, la cui ricerca spero di non aver travisato (ha curato la poesia secolare di Iain MacGilleain, e scritto la panoramica più dettagliata della poesia gaelica da immigrati scozzesi Highland a Nord America fino ad oggi). Come mi ricorda, anche la poesia di Iain MacGilleain che respinge la temperanza riconosce la stupidità di eccesso di bere. La chiave è la moderazione, e questo è abbastanza esplicito anche nella poesia di donne.

I miei pensieri su questo argomento sono stati ispirati da una lunga discussione con il mio amico Alastair McIntosh , il grande scrittore ed eco-spirituale, il poeta-sciamano di Govan, in Scozia, che ha condiviso con me un rapporto molto inquietante circa l’epidemia di abuso di sostanze in Scozia e l’ costi sociali per la nazione. Quale potrebbe essere alla radice di questi mali culturali pronunciati – di pari passo con il più basso autostima giovanile  in Europa occidentale, secondo l’Organizzazione Mondiale della Sanità – ma una narrativa nazionale di sconfitta e di inferiorità?

È anche possibile vedere il rapporto 2007 sugli abusi di alcol in Nuova Scozia in generale.

References

Robert Dunbar. “Poets of the Emigrant Generation.” Transactions of the Gaelic Society of Inverness 64 (2008): 22-125.

John MacInnes. Dùthchas nan Gàidheal: Selected Essays of John MacInnes, ed. Michael Newton. Edinburgh: Birlinn, 2006.

Michael Newton. A Handbook of the Scottish Gaelic World. Dublin: Four Courts Press, 2000.

— Warriors of the Word: The World of the Scottish Highlanders. Edinburgh: Birlinn, 2009.

— The Naughty Little Book of Gaelic. Sydney: Cape Breton University Press, forthcoming.

Effie Rankin. Ás a’ Bhràighe: Beyond the Braes. Sydney: Cape Breton University Press, 2004.

The newspapers are rubbish

From Beppe Grillo’s Blog

The newspapers are rubbish! Please: be curious. Please look at what’s behind what you hear in the news programmes. Because everything that you know is false and the truth is what you don’t know!” Beppe Grillo

Spin-doctor Tricks

beppe_grillo_giornali.jpg
“Sorry. I can’t stand this any more. I can’t stand it! The M5S cannot allow itself to lose the elections fighting the reality mystificators. It can’t! You have to become journalists for yourselves and hang upside down and look at the news from the opposite angle, because it’s not OK to read this stuff here! By now, there’s just one big lie. Parliament is promoting its own lie and the newspapers and other communication channels including the TV are putting out their own lies.
Now the abolition of the provinces is in all the newspapers: “abolish the provinces“.That’s not true. From when we started out, we’ve never put forward candidates for the provinces. Never! We never put forward candidates because we want to abolish the provinces. The only constitutional law that has been presented in Parliament was put forward by us! Go and read it! Nobody’s talking about it! You’re abolishing the provinces?! That’s not true. They are shamefully creating mystification about this, with all the newspapers and the journalists on their side!
The number of people in the town councils will increase by 26,500. They’re taking away the provinces and offloading all the people onto the towns. The departments in the town will grow by 5,000! And then there’s this puppet that goes round and round saying …. This is how it goes: they say “abolish the provinces”, then they go out into the streets and say that the only ones that voted against are the “grillini” {Grillo’s people}. Get it? Their story’s not true. You have to think about reality in a different way! Obama comes to Italy and goes to meet the Pope to get a few photos. He came here because he was worried about our reducing military spending on the F35 bombers. He came here to talk about this. And Napolitano immediately went to speak on TV to say we have to spend less! Obama came here to sell us his shale gas that he’s discovered will last for 100 years. And the biggest reserve in he world, one of the biggest is in Israel!
He came here to do furtive deals with his economy and we stay silent. No one squeaks! All stuff like that! It’s not possible! So I throw myself from the window. We all throw ourselves from the window. What’s to be done?! The game is being played out on an uneven playing field! We cannot think that lying is going to win everything….

I want you to rebel! We’ll take countermeasures. We’ll get a bus, a camper and we’ll put a gigantic loudspeaker on top and we’ll get there and sow the seeds of reality. In all these years I’ve shown you that I’ve never lied. We don’t want to be part of a coalition and we haven’t done that. We want them all to go home and we’ll send them home.
Now we’re going to Europe to change Italy from there. We’re going there and we’re going to get rid of the Fiscal Compact, get rid of the European Stability Mechanism (ESM), and get rid of the idea of a balanced budget to be sanctioned by the Constitution. If it doesn’t go well, then we’ll talk about spreading the debt, about eurobonds, and we’ll have a referendum on the Euro! And if we leave the Euro, it’ll have been the decision of the Italian people!

Pallative Care

As my wife said/says to me The people who  make cigarette tabacco are all liars, they say “Smoke Kills”, but you’re still alive” ?????????????????????????????????????????????????????????????????????????????????????

Associazione Gigi Ghirotti

associazione-gigi-ghirotti[1]

Gigi Ghirotti

I myself am not suffering from a terminal illness or in need of end of life care (at this very minute)  but a person very close to me is (my wife):

People from the Associazione Gigi Ghirotti (and a 1000…. thanks to them) are helping the patient, myself,  my family and friends
92_big_LogoFondazioneGhirotti[1]vivere-fino-alla-fine-libro[1]

 

Palliative care

What is it ?

Palliative care, which is defined as ‘the active total care of patients whose disease is not responsive to curative treatment’ traditionally  associated with the care of cancer patients.

Emphasis should be placed on improving quality of life for the patient and relieving troubling symptoms rather than prolonging life. Good palliative prescribing is important but drugs are rarely the total answer for the relief of pain and other symptoms. Always consider the psychological, social and spiritual needs of the person. The use of nondrug measures is as important as medication in relieving suffering.

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General principles

Try to follow a systematic approach to symptom control in palliative care:

  • Individualised treatment: the patient should determine treatment priorities. Set realistic goals of treatment together. Take precise drug histories – what is being taken currently, what has been tried before, problems with medication and concerns affecting concordance.
  • Supervision: regular monitoring of symptom control is important in order to ensure that the treatment goals are being achieved and to avoid unacceptable side-effects.

Other important palliative care prescribing issues:

  • Written advice – reinforce spoken instructions – a chart is usually helpful for the patient and family to work from, with timing, names of drugs and dose (as quantity of liquid, number of tablets, etc.) and purpose outlined.
  • Continuity of care – communication is essential between all prescribers (GP, out-of-hours service, palliative care specialists), nursing teams and pharmacists so all are aware of changes and so that the patient and family are not confused by any alterations to medication made. Availability of equipment and drugs needs to be assured, particularly out-of-hours, and changes in prescriptions should be anticipated to avoid delays in obtaining vital medication.
  • Progressive disease – will alter how drugs are handled. In particular, worsening renal failure will lead to an accumulation of morphine-6-glucuronide (active metabolite of morphine). Signs of morphine toxicity may develop (increasing drowsiness, myoclonic jerksdelirium) and the morphine dose should be reduced down or the dose interval increased. Severe hepatic insufficiency will affect the metabolism of morphine and similarly may necessitate a dose reduction.[3]
  • Individual differences – some patients may require very high doses of morphine compared with others – this may reflect age (older patients tend to require less), use of adjuvant drugs and nondrug measures, pharmacokinetic differences (absorption, hepatic and renal function), pain tolerance threshold, previous use of strong opioids, duration of treatment and adequacy of management of other symptoms.

Care of patients in the dying phase

Diagnosis of dying

One of the biggest barriers to good care of the dying is healthcare professionals’ reluctance to diagnose dying. Recognising the key signs and symptoms is an important clinical skill. In cancer patients, usually death is preceded by a gradual deterioration in functional status:

  • The patient becomes bed bound.
  • The patient is semicomatose.
  • The patient is able to manage sips of fluid only.
  • The patient can no longer manage oral drugs.

The predictability of the dying phase is not as clear in some other chronic incurable diseases. Where a patient is recognised by his healthcare team to be in the dying phase (within days or hours of death), this can be communicated to the patient, if appropriate, and to the relatives. Appropriate care goals and prescribing can also be put into place to facilitate a ‘good death’.

Prescribing when providing end of life care

  • Review current medication – stop all non-essentials. Also, stop any inappropriate monitoring (such as blood tests and vital signs).
  • Conversion to continuous subcutaneous infusion (CCSI) – see also separate article Syringe drivers. Essential drugs, eg opioids, anxiolytics, and antiemetics, should be converted to the SC route via a syringe driver in most instances. It is slightly more complicated where a patient has previously been using opioid transdermal patches (see below). The use of a ‘just in case’ box has been instituted in some areas, enabling these drugs to be prescribed in advance and stored at home until needed, once the dying trajectory has been recognised.
    • Restlessness and confusion:
      • Haloperidol (little sedative effect).
      • Levomepromazine.
      • Midazolam (useful where a patient is restless or fitting).
  • ìAs required medication should be prescribed and available, including:
    • Analgesics: eg diamorphine/morphine (as required dose will depend on regular dose).
    • Antiemetics: eg metoclopramide or levomepromazine.
    • Sedative: eg midazolam.
    • Antisecretory drug: eg hyoscine butylbromide.
    • Delirium: haloperidol.
  • Anticipatory prescribing should ensure that there is no delay in responding to a symptom if it occurs. All patients starting the Care Pathway for the last days of life at home should have diamorphine (or alternative), cyclizine, midazolam and hyoscine available in the home, with sufficient for use over a weekend (plus bank holidays). Do not omit water for injection.[10]
  • Patient comfort – consider, for example, the need for mouth care and urinary catheterisation or pads where the patient is incontinent.
  • Monitoring – regular checks should be made to ensure good symptom control is maintained and to assess response to any changes in medication. Also important is regular monitoring of syringe drivers to check for precipitation, discoloration and to ensure the driver is running at the correct rate. If there is evidence of an injection site reaction, if the infusion is running too slowly or if there is pain or obvious inflammation, the injection site should be changed.

Pain control

See  Pain control in palliative care.

Nausea and vomiting

See  Nausea and vomiting in palliative care.

Restlessness

Consider:

  • Pain/discomfort – the patient may not be able to communicate the source. Treat any reversible causes, eg catheterisation for urinary retention, bowel care for constipation, hyoscine to dry up excess secretions in the throat.
  • Opiate toxicity – the dose of morphine may need to be reduced as the patient’s renal function deteriorates.
  • Biochemical abnormalities such as hypercalcaemia and uraemia may cause restlessness but, in the end of life phase, it is not usually appropriate to check for them. They may be associated with delirium.
  • Psychological or spiritual distress.

Management options:

  • Haloperidol – less sedating.
  • Midazolam – sedating.
  • Levomepromazine – highly sedating; use in place of haloperidol if the patient remains agitated despite haloperidol and midazolam.

Dyspnoea

See  Dyspnoea in palliative care.

  • Usually multifactorial, as anxiety is almost always associated.
  • General measures – reassurance and explanation, upright positioning, good ventilation (fan, open window), chest physiotherapy and relaxation exercises.
  • Drug measures – nebulised saline, oral or SC morphine (start with oral morphine or equivalent), benzodiazepines (eg diazepam), oxygen (variable effect).

Palliative sedation and the doctrine of double effect

Prescribing for patients at the end of life is often full of ethical anxiety for the prescriber, particularly in situations where a person at the end of life faces refractory symptoms. Palliative sedation is the poorly defined practice of continuous deep sedation used in patients at the end of life where normal medical treatment is failing to relieve severe symptoms of pain or agitation, and the ultimate option is to sedate beyond perception of these symptoms.

Doctors are duty-bound to relieve suffering but not to cause the patient’s death. The use of medication to end someone’s life constitutes euthanasia and is currently illegal in the UK. However, the doctrine of double effect is widely accepted and refers to the use of higher doses of opioids and sedatives to relieve end of life suffering without the intention of causing the patient’s death, even though the risk of hastening death is foreseen. In reality, evidence suggests that palliative sedation in the last hours of life is not associated with shortened survival overall so that the doctrine of double effect need not routinely be invoked to excuse this aspect of end of life care.[14]

Info from http://www.patient.co.uk/doctor/Prescribing-in-Terminal-Care.htm

Vedi questo pagina : http://scienzareligione.blogspot.it/2013/11/11-novembresmartino-giornata-nazionale.html

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Genoa G8 – 13 Years After

Yesterday just passed by Piazza Alimonda in Genoa, where Carlo Giuliani died during the violence which occured 13 years ago.

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Apart from the young man’s tragic death many other people suffered violence and torture at the prison nearby Bolzaneto.
Only now some of the perperuators of this have been brought to trial.

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The Nice Guys
Leaders at the G-8 economic summit including (From L) Japanese Prime Minister Junichiro Koizumi, British Prime Minister Tony Blair, US President George W. Bush, French President Jacques Chirac, Italian Prime Minister Silvio Berlusconi, Russian President Vladamir Putin, Canadian Prime Minister Jean Chretien, German Chancellor Gerhard Schroeder, Belgian Prime Minister Guy Verhofstadt, and EU President Romano Prodi pose for a group photo at the Palazzo Ducale in Genoa, Italy 22 July, 2001 at the end of the G8 three-day summit.
Leaders at the G-8 economic summit inclu
Photo credit PHILIPPE DESMAZES/AFP/Getty Images)

Police look on ………………………. And the beat goes on
Dead man not walking

The Iron Heel
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Chronicle of the rise of an oligarchic tyranny in the United States. It is arguably the novel in which Jack London’s socialist views are most explicitly on display. A forerunner of soft science fiction novels and stories of the 1960s and ’70s, the book stresses future changes in society and politics while paying much less attention to technological changes

Brutality on the helpless
Policeman in the yellow shirt kicks young defenceless boy

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Take your Pick
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OTR’s On the run
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Everything under control
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The Lighthouse – Genoa

La Lanterna: a bit of history

If you like lighthouses!

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Today visitors can climb 172 steps, reach the first terrace (76 m above the sea level), and enjoy the breathtaking view of the port and the old city.

The whole area was restored by the Provincia di Genova between 1995 and 2004 and its other attractions, apart from the Lanterna, are the Museum and the Promenade.
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The Lanterna, symbol of Genoa and most important lighthouse of the city, is a 77-metre-high tower, made of two blocks, square in section, roughly of the same height, and both with a projecting terrace.
Built on a rock of 40 metres of height, the top of the Lanterna stands therefore at 117 metres above the sea level. Its light is visible from more than 50 kilometres away.
The Lanterna has welcomed vessels and boats and guided them into the harbour for centuries.

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According to unofficial sources, the first tower was built in 1128, and it was almost the same height and size of the present Lanterna, but for three orders of merlons. Fires of heather and gorse were lit on its top, as signals to approaching ships. Documents and chronicles mention the tower without telling us, however, the exact date of its construction. The books kept by the Maritime Authority of each period (the “Consoli del Mare”, “I Salvatori del Porto”, “I Padri del Comune e Salvatori del Peno” and the “Conservatori del Mare”) show how the town took great care of the Tower, to the extent that its edicts provided in detail for its maintenance and its keeping, exacting a special tax from each incoming vessel.

La Lanterna

In 1318, during the war between Guelphs and Ghibellines, the tower’s foundations were severely damaged by the Ghibeliine army. This led in 1321 to works aimed to reinforce the tower and make it better defendable: a moat was dug on purpose.

The first tower was built in 1128

According to unofficial sources, the first tower was built in 1128, and it was almost the same height and size of the present Lanterna, but for three orders of merlons. Fires of heather and gorse were lit on its top, as signals to approaching ships. Documents and chronicles mention the tower without telling us, however, the exact date of its construction. The books kept by the Maritime Authority of each period (the “Consoli del Mare”, “I Salvatori del Porto”, “I Padri del Comune e Salvatori del Peno” and the “Conservatori del Mare”) show how the town took great care of the Tower, to the extent that its edicts provided in detail for its maintenance and its keeping, exacting a special tax from each incoming vessel.
In 1318, during the war between Guelphs and Ghibellines, the tower’s foundations were severely damaged by the Ghibeliine army. This led in 1321 to works aimed to reinforce the tower and make it better defendable: a moat was dug on purpose.

Olive Oil as Fuel

The first light was installed in 1326, and its lamp was fuelled with olive oil. It shone in the dark nights, signalling the way into the city to the approaching ships and boats. In 1340 a painter from Milan, Evangelista, painted the Genoise coat of arms on the top of the Tower. The oldest drawing of the Lanterna dates back to 1371: it is a pen drawing on the parchment cover of a book, used by the “Salvatori del Porto” to keep trace of the expenditure for the oil and the lamp crystals, and of the appointments of keepers.

Used as a prison

In the Books of the Sea Consuls and of The Saviours of the Port all major events related to the Lanterna are dutifully reported. We learn among other things that:
– around 1400 the Tower was used as a prison (and it was here that, apparently, the king of Cyprus Giacomo from Luisignano and his wife were imprisoned for five years).
– in 1405 a fish and a golden metal cross were put on the top of the dome (at the time the Lighthouse keepers were priests).
– in 1413 an order issued by the Sea Consuls allocated a budget of 36 liras for the maintenance and the management of the lighthouse, whose importance for the safety of shipping was explicitly recognized
– in 1449 Antonio Colombo, Cristoforo Colombo’s paternal uncle, was appointed as one of the Lighthouse keepers
– in 1481, 1596 and again in 1602 lightning inflicted serious damage to the Lanterna.

 

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The New Tower 

In 1506, during the siege of the French-occupied fort of Briglia, the Genoese insurgents bombed the Tower by mistake and partially destroyed its upper part. It was only in 1543 that it was rebuilt and given the shape we can still see today. The new lantern room was built with wooden staves covered with copper and lead foils, kept together by more than 600 copper nails. Works went on up to 1681, when a new dome was built, partially destroyed only 3 years later, in 1684, when the French bombed the city from the sea.

Il Lanternino (The Small Lantern Room)

For many centuries the crystals for the Lantern Room were provided by artisans from Genoa and Venice. Surviving contracts between Genoese Consuls and master glass-makers tell us that in 1460 crystals used for the lantern were made of 244 pieces. Crystals had to be light and transparent and of set length and width.
Keepers were obliged to live in the lighthouse with their families, and had to polish and clean the glasses. They were given sea sponges and buckets, and egg white was used to clean them.

The illuminating system 

Before 1840, metal or glass lamps were in use. In 1840 the first rotating system using a Fresnel lens was put in place (Fire was still olive-oil fuelled). The fixed white light was visible from up to 15 miles away, with one-minute intervals of stronger light visible from 20 miles away.
In 1881 a special Commission in charge with the reorganization of the Italian lighthouse system proposed to build a new lighthouse on the Portofino headland. The Lanterna would eventually lose its importance. The Commission’s proposal was not, however, accepted, and the Lanterna, a few years later, became even more important.

The illuminating system was improved with the set up of an eight-panelled lenticular lens system. The range light was increased of 3.7 miles.
In 1913 the panel-based system was replaced by a new rotating mercury float system built in Paris by Henry Lapaute’s firm. The 1840 mm diameter optics was oil-vapor fuelled and could generate a 520,000 candlepower beam. It was rotated at a precise rate controlled by a clockwork mechanism (wound up every 5 hours).
Electrification of the Lanterna did not occur until 1936, when its candlepower was increased up to 745,000 DC.

Visiting the Lanterna

Visiting the Lanterna area is the ideal thing to do if you are in Genoa waiting for a ferry to somewhere (Sicily, Sardinia, Corsica, Tunisia…), and you’ve got a couple of spare hours; or if you’re just arriving here by ship, or you just want to enjoy an unusual, breathtaking view of the city, or – last but not least, of course – if you like lighthouses!

Genoa La Superba Day and Night

Come and visit the city – La Superba

Genoa by night An introduction to a beautiful city 8-old-port-night[1] Genoa by day

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The Old Port and famous Genoa Aquarium, the exterior of which was designed by Genoese architect Renzo Piano

  Genoa (Genova in Italian) is a major historical port city. It is located in the Northern part of Italy and it is the capital of a region called Liguria. The fortification of the city, the house where Christopher Colombus was born (in Piazza Dante).

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Porta Soprana

The Spianata Castelletto castle and the Aquarium are some of the most important attractions of Genoa.

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View from Spianata Castelletto

Moreover, the oldest lighthouse in Europe, called the Lanterna, can be seen in Genoa. The promenade Corso Italia is ideal for shopping thanks to its luxurious stores. There is also an area named Boccadasse which is known as the zone of the fishermen.

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Boccadasse

Boccadasse in a storm

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Stormt Day at Boccadasse

Corso Italia Promenade  at night

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Corso Italia

Corso Italia Promenade  by day

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Corso Italia with Punta Chiappa – Portofino in the background

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Corso Italia

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Monte Portofino

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Punta Chiappa Portofino

To be continued …………….

The Five Star Movement

An Introduction to the Five Star Movement 

Grillo and Casaleggio understood Italians’ need for something different. And everything about 5-Star is different.

Beppe Grillo
Beppe Grillo

A bit of their story:

The Founder

 Giuseppe Piero “Beppe” Grillo born 21 July 1948  is an Italian Comedian,actor,blogger and political activist . He has been involved in political activity since 2009.

His  performances began to display an increasing level of political satire, often expressed in such a direct way that he rapidly offended some Italian politicians. In 1987 during the Saturday night TV show Fantastico 7, he attacked the Italian Socialist Party and its leader Bettino Craxi, then Italy’s Prime Minister, on the occasion of his visit to the Peoples Rebublic of China (PRC).
The joke was:

A member of the Italian Socialist Party asked Craxi:
“If the Chinese are all socialists, who do they steal from”?

The joke alluded to the totalitarianism of the PRC, but even more to the widespread corruption for which the Italian Socialist Party was known.

As a consequence, Grillo was effectively banished from publicly owned television. He was vindicated a few years later when the Italian Socialist Party had to be disbanded in a welter of corruption scandals known as Tangentopoli, uncovered by the Mani pulite  (Clean Hands) investigation . Craxi himself died in Tunisia , unable to return to Italy where he would have been jailed on several convictions.

Grillo maintains a blog ( in Italian, English, and Japanese) at beppegrillo.it which is updated daily.

He is an ecologist with a largely left-wing platform based on attacking privilege, redistributing wealth, increasing public control of schools and healthcare, and cutting spending on defence. He believes in more direct democracy using referendums and the Internet and wants new laws to clean up politics.

 V‑Day Celebration – “V”  for vaffanculo (“fuck off“)

Grillo has spearheaded several national and international political campaigns. On 8 September 2007, he organized his first  “V‑Day Celebration” in Italy; the “V” stood for vaffanculo (“fuck off“). During the rally, Grillo projected the names of two dozen Italian politicians who had been convicted of crimes ranging from corruption and tax evasion to abetting a murder. More than 2 million Italians participated in this rally. Grillo also used the rally to urge Italians to sign a petition calling for the introduction of a “Bill of Popular Initiative” to remove from office Italian parliamentarians with criminal convictions.

Below is the list of names of Italian representatives in the Italian and European Parliaments that have been convicted of a crime: Check The List

cleanup[1]

 

On March 2013 Der Spiegel called Grillo as “The most dangerous man in Europe”, accusing him to be fascist and populist.
Accusations of undemocratic and even despotic behavior have since grown more frequent, as a number of members of parliament deemed unfit by Grillo were ousted from the movement.

 

The Guru

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“A single man in command is not democracy,” said Pier Luigi Bersani after his Democratic Party (PD) was beaten into second place in the vote. “Behind Bersani is the PD, I want to know what is behind Grillo.”

The answer is Casaleggio, and his Milan-based firm Casaleggio Associates whose business is to create websites and web-based marketing campaigns for clients.

Gianroberto Casaleggio born 14 August 1954 is an Italian entrepreneur andpolitical activist.
He is co-founder and chairman of Casaleggio Associati srl, an internet and publishing company that advises on network strategies, and editor of Beppe Grillo’s blog. He is also co-founder, with Beppe Grillo, of the Five Star Movement Five Star Movement, of which he is sometimes called “guru”.

The two men met in 2004 and the following year Casaleggio’s company created Grillo’s hugely successful blog. Casaleggio has been running Grillo’s public activities ever since. They are joint founders of the 5-Star Movement.

Ideology

In the Five Star Movement converge themes derived from ecological and anti-particracy promoting the direct participation of citizens in the management of public affairs through forms of digital democracy. The Movement wants to be a “democratic encounter outside of party and associative ties and without the mediation of directive or representational organisms, recognising to all users of the Internet the role of government and direction that is normally attributed to a few”.

From the economic point of view, embraces the theories of degrowth supporting the creation of “green jobs” and the rejection of polluting and expensive “great works”, including incinerators, aiming to an overall better quality of life and greater social justice. The Movement 5 Star proposes the adoption of large-scale energy projects, elimination of waste, sustainable mobility, protection of territory from overbuilding, teleworking.
In one of the best debut performances by any party in Western Europe since World War Two, 5-Star took 26 percent of the vote, outstripping the PD and Silvio Berlusconi’s centre-right People of Freedom.

To launch his party’s campaign for elections in Sicily last year he swam the Straits of Messina, a treacherous 3 km (2 mile) stretch of water that separates the island from mainland Italy.

Grillo and Casaleggio understood Italians’ need for something different. And everything about 5-Star is different.

Comments

“Unless the other parties change their leaders and somehow get back in touch with ordinary people he can certainly keep on growing,” said Elisabetta Gualmini, politics professor at the University of Bologna and a close observer of Grillo’s movement.

Some commentators have compared Grillo to Mussolini, seeing similar personality cults, the same vitriolic attacks on opponents and their common rejection of traditional parties.

While most of Grillo’s policies are light years away from those of the wartime dictator he, like Mussolini, possesses a rare charisma and an energy that belies his 64 years.

It is the only party that refuses state financing and its elected representatives have all voluntarily slashed their salaries. Its members never appear on television talk shows, it communicates almost exclusively through Grillo’s blog , and it refuses to form alliances with other parties.