bluuebunny/crossref_metadata_2025 huggingface dataset:
Section Overview
Authors: Ferlie Ewan , Ongaro Edoardo
Published: May 2023

The Europe section of the handbook provides an overview of welfare system changes in Europe till early 2020. The European region is of strong interest globally as a number of European countries were early pioneers in developing the modern welfare state after the model was introduced in Germany and the United Kingdom. Moreover, the European Union has played a vital role in shaping the administrative space for social policy in and beyond the region for many decades. As the chapters in this section highlight, there is not one Europe but many when it comes to welfare systems, social policy, and the public administrative systems into which welfare programs and other arrangements are embedded. The argument that context matters in public policy and management is reinforced throughout the section as the chapter authors review the key transformations that have defined welfare governance, management, and policy over time in Europe. This overview chapter introduces the other chapters and highlights the value of applying historical analysis to illuminate the variety of change trajectories across European welfare states alongside important global influences, including the impact of the Global Financial Crisis (GFC) and the trend toward redefining welfare professions and the nature of social work in line with the notion of whistleblowers.
Social Services Fragmentation
Authors: Eppel Elizabeth , Allen Barbara
Published: May 2023

Public sector reform in New Zealand in the 1980s fragmented the design and delivery of social services. Sector focused omnibus agencies such as the ministries or departments of health, education, and social welfare were broken up into smaller agencies focused either on policy design and monitoring or delivery of specific services. The result was considerable fragmentation of social services and inability to serve the social sector in a holistic way based on need, particularly needs spanning more than one sector or agency. Much experimentation, ad hoc workarounds, structural reintegration of policy, service delivery organizations, and virtual ways of bridging service silos emerged in the ensuing 30 years. Important motivators for attempts at reintegration were moves to focus on outcomes and citizen-centric design of services. More joining up of services across government, collaboration across government, and the use of digital information systems were among the mechanisms used.
The Changed Role and Position of Professionals in the Welfare State Across Europe
Authors: van Gestel Nicolette
Published: May 2023

This chapter offers a broad overview of the changing role and position of professionals in European welfare states, where successive reforms have made professionals’ jobs more diverse, dynamic, and demanding. The resulting multifaceted job of professionals goes beyond combining professional work and management tasks and includes at least three different roles—being an expert, a service provider, and a network partner. Simultaneously, with growing expectations, professionals’ authority and dominance have declined against a background of growing economic and social pressures. Overall, professionals can rely less on traditional status but increasingly need to convince clients, managers, politicians, and the wider public of their expertise and contribution. Within the limits of this brief chapter, current experiences of key professions in selected European countries are presented. The chapter discusses variations between professional groups due to diverse relationships with the state and differences between welfare state regimes.
Evolution, Trends, and Prospects of Social Services for Welfare Systems in Europe
Authors: Borgonovi Elio , Fosti Giovanni , Notarnicola Elisabetta
Published: May 2023

This chapter describes the evolution of social services in Europe, setting the picture in the frame of the changing profile of European societies and demographics, on one hand; and the changed configuration and role of public administration, on the other hand. Changes to welfare systems in Europe have occurred at different levels, including the mission and goals of welfare institutions, the actors providing social services, the arrangements for the delivery of social services, and the funding of services. In terms of mission and goals, the trend has been away from social assistance and toward emphasizing social inclusion. In terms of governance and actors within the welfare system, the tendency has been from public entities to an emphasis on hybrid organizations and public–private partnerships. In terms of the arrangements for service provision, the trend has been from cash allowances toward forms of user involvement, co-design, and co-production. Finally, in terms of funding, we observe a trend from “generous” public funding to a mixing of public and private sources, a general fragmentation, and, often, an overall reduction in the funding of welfare.
Co-innovation in Welfare States Across Europe
Authors: Torfing Jacob
Published: May 2023

Until now, innovation research has mostly focused on innovation in the private sector where private firms must innovate to stay in business. Today, there is a growing appreciation of the internal and external pressures for stimulating innovation in the public sector. Researchers and practitioners tend to agree that the public sector should pursue innovation, but there is little agreement about how this can be done. After a brief review of the limited innovation capacity of both the hierarchical forms of public bureaucracy and more market-based forms of New Public Management, this chapter seeks to define and analyze the new phenomenon of co-innovation that is based on complex processes of multi-actor collaboration enabling the co-creation of innovative public value outcomes. It also provides illustrative empirical examples of co-innovation in European welfare states and sets an agenda for further research.
Effects of Parasocial Experiences With Spokespersons on Consumer Behavior
Authors: Munnukka Juha , Reinikainen Hanna
Published: May 2023

This chapter discusses the utility of examining parasocial experiences (PSEs) in marketing, communication, and advertising research, specifically in the context of brand and product endorsements. The role of PSEs in various theories of persuasion in consumer research is applied to two domains: traditional celebrity endorsements on legacy media and social media and endorsements made by social media influencers, such as YouTubers and Instagram celebrities. Further, the chapter explicates the differences between these two types of media figures in the context of brand and product endorsements and discusses the unique importance of PSEs in driving their effects. Finally, a review of research and theoretical models highlights the importance of PSEs in the underlying effects of endorsers.
Initiation and Evolution of PSRs
Authors: Walter Nathan , Andrews Emily A. , Tukachinsky Forster Rebecca
Published: May 2023

Most research examines parasocial relationships (PSRs) with cross-sectional designs. However, by nature, relationships evolve over time and need to be managed and nurtured if they are to thrive. The chapter offers an account of the key predictors in the initiation and evolution of positive, amicable PSRs. This chapter addresses the dynamic nature of PSRs by providing an overview of the literature concerning factors that predict the initiation and continued growth of PSRs. The chapter then turns to describe three theoretical models that conceptualize PSRs as an ever-evolving process. The chapter concludes by highlighting several promising areas for future research into the initiation and development of PSRs.
Ethiopian languages and their demographic distribution
Authors: Meyer Ronny , Yigezu Moges
Published: May 2023

This chapter provides an overview of the sociolinguistic status of Ethiopian languages according to the four major language families in Ethiopia: Cushitic, Omotic, Semitic, and Nilo-Saharan. The authors classify Ethiopia languages into three groups: (i) large languages; (ii) sizeable languages; and (iii) small languages. They argue that there is an ongoing language shift from small to large and sizeable languages, which implies that small languages are being steadily marginalized. This chapter then also discusses the vitality of Ethiopian languages by dividing them into the following types: living vernacular languages, extinct (or dormant) languages, sign languages, and foreign languages. The current state of languages in Ethiopia is a result of socio-historical developments. Ethiopia is a multilingual society, in which Amharic became the de facto Ethiopian lingua franca, and functions as the working language of central and local government.
Awngi
Authors: Leyew Zelealem , Allene Yaregal
Published: May 2023

This chapter deals with Awngi—a language of the Central Cushitic, or Agaw, group. Awngi is mainly spoken in northwestern Ethiopia in the Awi Zone of the Amhara Regional State and in some villages of the Benishangul-Gumuz Regional State. The chapter reviews the dialectal differences between the Awngi varieties spoken in the highland (Agaw-Midir) and lowland (Metekkel) and its impact on mutual intelligibility. This chapter also analyzes the Awngi consonant phonemes, including the five labiovelar consonants. It also explores Awngi nouns, verbs, and adjectives, and nominal derivation.
Saaho
Authors: Banti Giorgio , Vergari Moreno
Published: May 2023

This chapter focuses on the Saaho language. It emphasizes that Saaho is the term used for the varieties spoken by the Saaho of Eritrea and the Irob of Ethiopia. Saaho and Afar form a dialect continuum, regarded as a subgroup of Lowland East Cushitic. A large number of Saaho are now living in the diaspora where their language is still widely spoken and is also commonly used on the internet and social networks. The three major dialect groups within Saaho are briefly discussed: (i) Northern, mainly spoken by the Tʼaruuʕa and the ʕAsawurta, (ii) Central, mainly spoken by the Minifire and the Dabrimeela, and (iii) Southern, mainly used by the Ħado and the Irob. This chapter then shifts to elaborate on the different aspects of Saaho grammar, dialectology, and lexicography. After identifying the major phonological, grammatical, and lexical isoglosses that distinguish the main Saaho and Afar dialects, the phonology of Saaho is analyzed. This is followed by a discussion of the main word classes of this language and their morphological peculiarities. Finally several aspects of Saaho syntax and pragmatics are outlined, such as the structure of simple sentences, comparison and possession, negation, coordination and subordination, direct and indirect speech, definiteness, focus and topic, as well as allocutives.
Sidaama
Authors: Kawachi Kazuhiro
Published: May 2023

This chapter provides a sketch of the Sidaama grammar, a Highland East Cushitic language spoken in the Sidaama Zone of south-central Ethiopia. After giving very brief background information on this language, the chapter outlines the phonological system, lexical and grammatical categories, the morphology of Sidaama verbs, nouns, and adjectives, and the structure of single-verb, multi-verb, and complex-clause constructions. Phenomena of particular typological interest include noun-phrase clitics, the modification and the modification distinctions of nouns, and external possessor constructions. The chapter also deals with different types of speech reports as well as focus- and topic-marking strategies, and cleft-constructions to mark topics.
General overview of Ethiosemitic
Authors: Kapeliuk Olga
Published: May 2023

Several theories were suggested as to the origin of Ethiosemitic, ranging from the immigration by one or several waves of speakers of Semitic from South Arabia to the Western coast of the Red Sea and up to the designation of East Africa as the original habitat of Semites in general. Ethiosemitic, at all its stages, conforms to the basic structure of Semitic with discontinuous consonantal roots providing the basic meaning and fixed patterns of vowels, inserted between them, rendering the grammar and lexicon. Modern Ethiosemitic is characterized by phonemization of labialized velar consonants; by the presence of palatalization; by the reduction of short i and u to zero or to the central short vowel ǝ; by the creation of a plethora of new verb stems through reduplication of one of the syllables of the basic verb; by the creation of a copula replacing nominal sentences and, under the influence of co-territorial Cushitic, by an overall change of word order running gradually from the relatively less important information to the most important, namely to the main predicate and the negation, both placed at the end of the sentence.
Nuer
Authors: Faust Noam , Grossman Eitan
Published: May 2023

This chapter covers the Eastern Jikany variety of Nuer, a Western Nilotic language spoken in South Sudan and the border of Ethiopia. Noteworthy phenomena in the language include: (1) vowel mutation as a main morphological tool, due to size restrictions; (2) complex non-linear morphology; (3) reduplication on adjectives; (4) a fundamental morphological distinction between transitive and intransitive verbs; (5) a sg-pl system with a direction of derivation depending on the item; (6) rich possessive morphology; (7) differential object marking; and (8) an aspect-based word order split in main declarative clauses.
Suri (Tirmaga-Chai)
Authors: Bryant Michael
Published: May 2023

This chapter discusses the Tirmaga-Chai language recorded among the Suri people living in Southwest Ethiopia near the border of South Sudan. Dizi, Suri (Kacipo-Balesi), and Amharic are the languages with the most contact with Suri, especially with Amharic as the language of wider communication in Ethiopia. The Tirmaga-Chai, and Suri Woreda representatives have chosen their orthography based on a modified Roman script with the indication of grammatical tone. Tirmaga-Chai has an inventory of 22 consonants and 7 vowels which have suprasegmental features such as vowel length, gemination and tone. The language is fairly polysynthetic with most morphemes being agglutinative, although some are fusional. It predominately has SVO word order and is considered to be a nominative-accusative language.
General overview of Omotic
Authors: Theil Rolf
Published: May 2023

This chapter provides a general overview of the Omotic language cluster, which has around 30 languages within it. Most of the Omotic languages are spoken and recorded in southwest Ethiopia, and are divided into Central Omotic and Peripheral Omotic. Moreover, Central Omotic is recognized as a genetic group. The chapter discusses the hypotheses for the affiliation of Cushitic, Cushomotic, non(Cushitic, non-Erythraean, and non-Afroasiatic languages. It covers the debates on the methods of classifying Omotic languages, including Greenberg’s mass comparison and Morris Swadesh’s lexicostatistics and glottochronology. The sources of Omotic languages range between Ometo, Gonga, Bench, Ts’aara, Yemsa, Aroid, Maoid, and Dizoid.
Wolaytta
Authors: Wakasa Motomichi
Published: May 2023

This chapter discusses the Wolaytta language, which belongs to the Omotic branch of the Afroasiatic phylum. Wolaytta is used for everyday conversation, schooling, and pop songs. Pitch is used distinctively when speaking Wolaytta as it is deemed as a word-accent language. Moreover, Wolaytta verbs and nominals are classified into groups: Accent Class I and Accent Class II. On the other hand, the orthography of Wolaytta is based on the Roman script. Most Wolaytta words consist of a lexical stem and a grammatical ending, as part of a specific inflectional paradigm or derivations. Based on these endings, words can be divided into two major classes: verbs and nominals. Common nouns inflect for concreteness, as well as gender, number, and case. For reporting utterances of others, Wolaytta prefers a mix of direct and indirect speech.
Dialectics That Sweep Away ‘COWDUNG’
Authors: Lala Kevin , Feldman Marc , Odling-Smee John
Published: May 2023

Developmental geneticist Conrad Waddington and evolutionary biologist Richard Lewontin, two of the pioneers of niche construction theory, were explicit in regarding organisms as co-directing their own evolution. In The Ethical Animal (1960), Waddington anticipated features of contemporary cultural evolution theory, including the evolutionary significance of cultural norms. Lewontin was suspicious of evolutionary accounts of human behaviour, which he viewed as governed by political forces and power relations, and in The Dialectical Biologist (1985) stressed how scientific enquiry could be biased by politics. Here the authors suggest that Waddington’s emphasis on ethical considerations, and Lewontin’s admonitions concerning sociopolitical interpretation of biological research, remain relevant to the field of cultural evolution, and they review some related scientific controversies. The authors argue that human cultural activities not only construct evolutionary and cultural niches, but also scientific niches. This reasoning applies to both contemporary debates within the evolutionary human sciences and wider evolutionary theory, including niche construction theory itself.
The Battle of the Atlantic, 1939–1945
Authors: Milner Marc
Published: May 2023

The Battle of the Atlantic is a misnomer for the six-year long struggle over the movement of merchant shipping in the Atlantic Ocean. It was not a discrete battle in the conventional sense, but a series of campaigns initiated by the Germans to either defeat the Western Allies outright or impede the development of their military power and strategy. Only in the winter of 1940–1941, when Great Britain was essentially alone and isolated, could German efforts at sea have won the war through a blockade of Britain. However, they lacked the resources to do so. Thereafter, Germany focused on checking the growth of Allied military power, especially the potential for a Second Front, and relied increasingly on U-boats (submarines). Losses to Allied merchant shipping remained high until 1943, when increased numbers of Allied escorts and aircraft employing improved equipment, tactics, and naval intelligence combined to effectively check Germany’s submarine campaign.
Reintegrating Veterans and Demobilizing Populations
Authors: Douglas R. M.
Published: May 2023

The process of reversing wartime mobilization efforts and returning uprooted civilian populations home was always going to be fraught with difficulty. The victorious Allies made it considerably more so by the decisions they took in the immediate postwar years. Learning lessons from the Great War, they did surmount the challenge of demobilization with reasonable success. Their choice in 1945 to replace one prisoner-of-war population with another, however, was ill-advised. Retaining Axis POWs behind barbed wire prolonged the disruption caused by the war and undermined the ideals for which it had been fought. A still more destructive initiative was the postwar experiment in mass population transfers in central Europe even as the Allies struggled to repatriate the victims of the Nazis’ vicious precedent in this regard—the so-called “displaced persons.” Forced postwar migrations gave rise to an immense man-made refugee crisis whose damaging effects remain visible to the present day.
Forging Alliances
Authors: Law Ricky W.
Published: May 2023

This chapter traces the history of the Axis alliance of Germany, Italy, and Japan from its origins after World War I to its defeat in 1945. The rise of Hitler and Nazism played an indispensable role in the formation of the Axis. Nazi ideology nurtured affinity with Italian Fascists and Japanese militarists, while Nazi diplomacy departed from traditional German foreign policy. In 1936, Germany reached separate arrangements with Italy and Japan. Germany and Italy concluded the Pact of Steel in 1939. The next year, Japan joined the military alliance to create the Tripartite Pact. German battlefield successes drew Italy, Japan, and other countries closer to Germany. The Axis acquired common enemies in late 1941, but its member states focused on their own distinct campaigns rather than helping each other. What had made the Axis possible in peacetime, its members’ discrete territorial ambitions, turned out to be its greatest weakness in war.
Pearl Harbor and Japan Ascendant
Authors: Pash Sidney
Published: May 2023

This chapter considers two related topics: the events leading up to the Japanese attack on Pearl Harbor and the opening six months of World War II in Asia and the Pacific. For the better part of a generation, successive Japanese and American administrations had negotiated competing ambitions in China and often opposing interpretations of the Open Door policy. By the autumn of 1941, however, a decade of Japanese militarism and ultranationalism combined with the ongoing Sino–Japanese War and the growing spread of war in Europe, undermined U.S.–Japanese relations. With the onset of war in December 1941, the Japanese military proved all but unbeatable for the first six months, routing Allied forces in nearly every major engagement in Southeast Asia, including the Dutch East Indies, Singapore, and the Philippines, and in the Pacific at Guam and Wake Island.
The Air War and Conflict Termination in the Pacific
Authors: Crane Conrad C.
Published: May 2023

Airpower was an essential enabler for both General Douglas MacArthur’s assault through the Southwest Pacific to the Philippines and Admiral Chester Nimitz’s drive through the Central Pacific to Okinawa. As they got closer to the Japanese Home Islands, airmen began to focus on targets there, using the new long range B-29 bomber. Operations from China were disappointing, but eventually all the Superfortresses were concentrated in the Mariana Islands. From those bases, General Curtis LeMay launched a devastating fire bombing campaign against enemy cities, and the secretive 509th Composite Group dropped atomic bombs on Hiroshima and Nagasaki. All these actions were key components in the series of blows that eventually produced Japanese surrender.
Retention, safety and efficacy of off-label conventional treatments and biologics for chronic calcium pyrophosphate crystal inflammatory arthritis
Authors: Damart Julien , Filippou Georgios , Andrès Mariano , Cipolletta Edoardo , Sirotti Silvia , Carboni Davide , Filippucci Emilio , Diez Pilar , Abhishek Abhishek , Latourte Augustin , Ea Hang-Korng , Ottaviani Sébastien , Letarouilly Jean-Guillaume , Desbarbieux Renaud , Graf Sahara , Norberciak Laurène , Richette Pascal , Pascart Tristan
Published: May 2023

Objectives

Very little is known on the efficacy and safety of drugs for the management of chronic calcium pyrophosphate (CPP) crystal inflammatory arthritis. The objectives of this work were to describe the drugs used in the management of chronic CPP crystal inflammatory arthritis in expert European centres, and to examine treatment retention.

Methods

This was a retrospective cohort study. Charts from patients with a diagnosis of persistent inflammatory and/or recurrent acute CPP crystal arthritis were reviewed in seven European centres. Baseline characteristics were collected, and visits at months 3, 6, 12 and 24 included an assessment of treatment response and safety.

Results

One hundred and ninety-four treatments were initiated in 129 patients. Colchicine (used first-line in n = 73/86), methotrexate (used first-line in n = 14/36), anakinra (n = 27) and tocilizumab (n = 25) were the most prescribed treatments, while long-term corticosteroids, hydroxychloroquine, canakinumab and sarilumab were used occasionally. The 24-month on-drug retention was higher for tocilizumab (40%) than anakinra (18.5%) (P < 0.05), while the difference between colchicine (29.1%) and methotrexate (44.4%) was not statistically significant (P = 0.10). Adverse events led to 14.1% of colchicine discontinuations (100% of diarrhoea), 4.3% for methotrexate, 31.8% for anakinra and 20% for tocilizumab; all other discontinuations were related to insufficient response or losses to follow-up. Efficacy outcomes did not differ significantly between treatments throughout follow-up.

Conclusion

Daily colchicine is the first-line therapy used in chronic CPP crystal inflammatory arthritis, which is considered efficient in a third to half of cases. Second-line treatments include methotrexate and tocilizumab, which have higher retention than anakinra.
A Booklet on the Assessment, Prevention, and Treatment of Incontinence-Associated Dermatitis
Authors: Salomé Geraldo Magela
Published: May 2023

OBJECTIVE

Printed materials have been used as educational resources to assist healthcare professionals in evidence-based clinical practice by providing guidelines for treatment, prevention, and self-care. The aim of this study was to develop and validate a booklet on the risk assessment, prevention, and treatment of incontinence-associated dermatitis.

METHODS

This was a descriptive, analytic, and quantitative study. The booklet was developed in six steps: situational diagnosis, development of the research question, integrative review of the literature, synthesis of knowledge, structuring and design, and validation of the content. An expert panel composed of 27 experienced nurses carried out content validation using the Delphi technique. The content validity index (CVI) and Cronbach α coefficient were calculated.

RESULTS

The mean Cronbach α for the evaluation questionnaire was .91, indicating excellent internal consistency. The evaluators classified the content of the booklet from “inadequate” to “totally adequate” (overall CVI, 0.91) in the first round of consultation and from “adequate” and “totally adequate” (overall CVI, 1.0) in a second round of consultation. The booklet was therefore considered validated.

CONCLUSIONS

A booklet on risk assessment, prevention, and treatment of incontinence-associated dermatitis was created and validated by an expert panel, obtaining 100% consensus among the evaluators in the second round of consultation.
Delirium after COVID-19 vaccination in older adults
Authors: Armstrong Kathleen
Published: May 2023

The COVID-19 global pandemic has devastated the older adult population. Like all vaccines, adverse reactions of COVID-19 vaccines are possible. This article discusses the increased incidence of delirium and delirium-associated symptoms in older adults following COVID-19 vaccinations.
Short bowel syndrome with intestinal failure in adults
Authors: Vaz Christine , Shannon Mary , Zaloom Joan
Published: May 2023

Short bowel syndrome is a rare condition that can lead to intestinal failure. It occurs as a congenital condition or due to massive small bowel resection. This article provides an overview of this condition in adult patients, including diagnosis and treatment in inpatient and outpatient settings.
Association of PM2.5 from agriculture sources and acute myocardial infarction onset: results from 2015 to 2018 in China
Authors: Du Peng , Lu Kailai , Zhang Can , Liu Ting , Hu Jianlin , Li Tiantian
Published: May 2023

Background and purpose:

Acute myocardial infarction (AMI) is a manifestation of coronary artery disease. Fine particulate matter (PM2.5) has been regarded as a risk factor for AMI-related mortality and hospitalizations. Agricultural activities contribute greatly to PM2.5 formation, indicating potential health risks of PM2.5 in agricultural areas. Health effect studies on agricultural source remain scarce, and currently available evidence is controversial. This study investigated the health effects of short-term exposure to PM2.5 from agricultural sources on AMI onset using a nationwide analysis in China.

Methods:

We reviewed case records from the China Cardiovascular Association Database and extracted the data of 355,815 patients with AMI onset from 1,653 hospitals for the period 2015 to 2018. We obtained daily concentrations of PM2.5 from agricultural sources using the source-oriented Community Multiscale Air Quality model. Moreover, we proposed a time-stratified case-crossover study to examine associations between exposure to PM2.5 from agricultural sources and AMI onset and determined lag effects with a maximum of 3 days. Additionally, we conducted multiple subgroup and sensitivity analyses.

Results:

Exposure to PM2.5 caused a significantly increased risk of the onset of AMI and its subtypes. Short-term exposure to PM2.5 from agricultural sources on the current day (lag 0) was positively associated with a 4.4% (95% confidence interval [95% CI]: 3.3%–5.5%), 4.9% (95% CI: 3.5%–6.3%), and 3.4% (95% CI: 1.5%–5.4%) increase in the odds of AMI, ST-elevation myocardial infarction (STEMI), and non-STEMI (NSTEMI), for each 10 μg/m3 increase. Meanwhile, higher risk estimations were pronounced in individuals who were aged above 65 years, who lived in southern China, and who resided in the rural area setting, and significant differences were mostly found in NSTEMI onsets.

Conclusions:

Short-term exposure to PM2.5 from agricultural sources may trigger the onset of AMI and its two subtypes. Improving agriculture management through ammonia emission abatement can help in achieving PM2.5 reduction and protecting public health.
Role of the internet of medical things in care for patients with interstitial lung disease
Authors: Nakshbandi Gizal , Moor Catharina C. , Wijsenbeek Marlies S.
Published: May 2023

Purpose of review

Online technologies play an increasing role in facilitating care for patients with interstitial lung disease (ILD). In this review, we will give an overview of different applications of the internet of medical things (IoMT) for patients with ILD.

Recent findings

Various applications of the IoMT, including teleconsultations, virtual MDTs, digital information, and online peer support, are now used in daily care of patients with ILD. Several studies showed that other IoMT applications, such as online home monitoring and telerehabilitation, seem feasible and reliable, but widespread implementation in clinical practice is lacking. The use of artificial intelligence algorithms and online data clouds in ILD is still in its infancy, but has the potential to improve remote, outpatient clinic, and in-hospital care processes. Further studies in large real-world cohorts to confirm and clinically validate results from previous studies are needed.

We believe that in the near future innovative technologies, facilitated by the IoMT, will further enhance individually targeted treatment for patients with ILD by interlinking and combining data from various sources.
Diabetes and prediabetes in children with cystic fibrosis
Authors: Schiaffini Riccardo , Pampanini Valentina
Published: May 2023

Purpose of review

Glucose metabolism alterations in cystic fibrosis range from the classic cystic fibrosis-related diabetes (CFRD) to forms of glucose intolerance and prediabetes. The aim of the present work is to review the most up-to-date novelties in terms of CFRD diagnosis and therapy. This review is timely and relevant because it allows an update for the early and correct classification of glucose abnormalities in cystic fibrosis and because it favours an appropriate therapeutic approach.

Recent findings

Confirm that Oral Glucose Tolerance Test is still the diagnostic gold standard despite the advent of continuous glucose monitoring (CGM) systems; this latter is spreading very rapidly, however, to date, there is still no strong evidence to hypothesize the use of CGM for diagnostic purposes. CGM has indeed proven to be very useful in managing and guiding CFRD therapy.

Tailored and personalized insulin therapy is still the recommended therapy for children and adolescents with CFRD, although nutritional intervention and oral hypoglycaemic treatment are equally important and efficacious. Finally CFTR modulators have allowed the increase of the life expectancy of cystic fibrosis patients and have proven effective not only in improving the pulmonary function and the nutritional status but also the glucose control.
Previous Sexually Transmitted Infections and Partner Services Interviews as Predictors of Subsequent Interview Completion Among Cisgender MSM: Partner Services Fatigue?
Authors: Barry Michael P. , Thibault Christina S. , Berzkalns Anna , Spellman Dawn R. , Rowlinson Emily , Barbee Lindley A. , Golden Matthew R. , Kerani Roxanne P.
Published: May 2023

Background

Anecdotal reports suggest that partner services (PS) are less successful among people with repeat sexually transmitted infection (STI) diagnoses and/or previous PS interactions. We examine whether having repeated STI diagnoses and/or PS interactions is associated with PS outcomes among men who have sex with men (MSM).

Methods

With STI surveillance and PS data for MSM diagnosed with gonorrhea, chlamydia, and/or syphilis from 2007 to 2018, in King County, WA, we used Poisson regression models to examine the relationships between PS outcomes (e.g., completing a PS interview and providing identifying information for a contact) with (1) number of previous STI case episodes and (2) number of previous PS interviews completed.

Results

Of the 18,501 MSM STI case patients initiated for interview in the analytic period (2011–2018), 13,232 (72%) completed a PS interview, and 8,030 (43%) had at least 1 prior PS interview. The proportion of initiated cases successfully interviewed declined from 71% among those with no previous PS interview to 66% among those with ≥3 prior interviews. Similarly, the proportion of interviews with ≥1 partner identified declined with greater numbers of previous PS interviews (from 46% [0 interviews] to 35% [≥3 interviews]). In multivariate models, having ≥1 prior PS interview was negatively associated with completing a subsequent interview and providing partner locating information.

Conclusions

Having a history of STI PS interviews is associated with less PS engagement among MSM. New approaches to PS should be explored to address the growing epidemic of STIs among MSM.
The Gonococcal Genetic Island defines distinct sub-populations of Neisseria gonorrhoeae
Authors: Youngblom Madison A. , Shockey Abigail C. , Callaghan Melanie M. , Dillard Joseph P. , Pepperell Caitlin S.
Published: May 2023

The incidence of gonorrhoea is increasing at an alarming pace, and therapeutic options continue to narrow as a result of worsening drug resistance.

Neisseria gonorrhoeae

is naturally competent, allowing the organism to adapt rapidly to selection pressures including antibiotics. A sub-population of

N. gonorrhoeae

carries the Gonococcal Genetic Island (GGI), which encodes a type IV secretion system (T4SS) that secretes chromosomal DNA. Previous research has shown that the GGI increases transformation efficiency in vitro, but the extent to which it contributes to horizontal gene transfer (HGT) during infection is unknown. Here we analysed genomic data from clinical isolates of

N. gonorrhoeae

to better characterize GGI+ and GGI− sub-populations and to delineate patterns of variation at the locus itself. We found the element segregating at an intermediate frequency (61%), and it appears to act as a mobile genetic element with examples of gain, loss, exchange and intra-locus recombination within our sample. We further found evidence suggesting that GGI+ and GGI− sub-populations preferentially inhabit distinct niches with different opportunities for HGT. Previously, GGI+ isolates were reported to be associated with more severe clinical infections, and our results suggest this could be related to metal-ion trafficking and biofilm formation. The co-segregation of GGI+ and GGI− isolates despite mobility of the element suggests that both niches inhabited by

N. gonorrhoeae

remain important to its overall persistence as has been demonstrated previously for cervical- and urethral-adapted sub-populations. These data emphasize the complex population structure of

N. gonorrhoeae

and its capacity to adapt to diverse niches.
Real-world performance and safety of Cerviron® medical device in the treatment of various types of vaginitis
Authors: Petre Izabella , Sirbu Daniela Teodora , Petrita Ramona , Calancea Florentina Liliana , Toma Andreea-Denisa , Peta Ema , Dimcevici-Poesina Florentina
Published: May 2023

A collection of clinical data was conducted to assess the performance and tolerability of Cerviron®ovules in the treatment and management of various types of vaginitis in clinical practice. A total of 111 women aged between 20 and 70 years were included, 71 of whom were treated with Cerviron®ovules as monotherapy and 40 who used Cerviron®ovules as supportive treatment in conjunction with antibiotic therapy. The aim of our study was to assess the relief in vaginal symptoms and changes in the normal vaginal pH level after 3 months of treatment with Cerviron®medical device in real-life clinical practice settings. The results showed that Cerviron®ovules are well tolerated and effective as monotherapy and also as an adjuvant to antibiotic therapy. The study and its details are registered inwww.clinicaltrials.govunder IDNCT05652959.
Impact of sarcopenic obesity on post-hepatectomy bile leakage for hepatocellular carcinoma
Authors: Hayashi Hikaru , Shimizu Akira , Kubota Koji , Notake Tsuyoshi , Masuo Hitoshi , Yoshizawa Takahiro , Hosoda Kiyotaka , Sakai Hiroki , Yasukawa Koya , Soejima Yuji
Published: May 2023

Background

Post-hepatectomy bile leakage (PHBL) is a potentially fatal complication that can arise after hepatectomy. Previous studies have identified obesity as a risk factor for PHBL. Therefore, we investigated the impact of sarcopenic obesity on PHBL in hepatocellular carcinoma (HCC) patients.

Methods

In total, we enrolled 409 patients who underwent hepatectomy without bilioenteric anastomosis for HCC between January 2010 and August 2021. Patients were grouped according to the presence or absence of PHBL. Patient characteristics including body mass index and sarcopenic obesity were then analyzed for predictive factors for PHBL.

Results

Among the 409 HCC patients included in this study, 39 developed PHBL. Male gender, hypertension and cardiac disease, white blood cell counts, the psoas muscle area and visceral fat area, and intraoperative blood loss were significantly increased in the PHBL (+) group compared with the PHBL (−) group. Multivariate analysis showed that independent risk factors for the occurrence of PHBL were intraoperative blood loss ≥370 mL and sarcopenic obesity.

Conclusion

Our results show that it is important to understand whether a patient is at high risk for PHBL prior to surgery and especially to reduce intraoperative blood loss during surgery for patients with risk factors for PHBL.
Bi-allelicNIT1variants cause small vessel disease with movement disorders and massive non-lobar intracerebral haemorrhage
Authors: Rutten J.W. , Cerfontaine M.N. , Dijkstra K.L. , Mulder A.A. , Kruit M. , de Koning R. , de Bot S.T. , van Nieuwenhuizen K.M. , Baelde J.J. , Berendse H.W. , Ruijter G.J.G , Baas F. , Jost C.R. , van Duinen S.G. , Nibbeling E.A.R. , Gravesteijn G. , Lesnik Oberstein S.A.J.
Published: May 2023

Highly penetrant monogenic causes of intracerebral haemorrhage are rare, and are almost exclusively hereditary cerebral amyloid angiopathies caused by heterozygous pathogenic variants in theAPPgene. Here, we identified a novel genetic cause of mid-adult onset non-lobar ICH, caused by bi-allelic pathogenic variants in theNIT1gene. The seven identified patients from five unrelated pedigrees presented with movement disorders, slowly progressive cognitive decline, ischemic strokes and psychiatric disturbances. All patients shared a striking neuroimaging phenotype with a honeycomb appearance of the basal ganglia due to an extremely high burden of enlarged perivascular spaces. Two patients were deceased, due to mid-adult massive non-lobar intracerebral haemorrhage. Small cerebral arteries showed strongly abnormal morphology, with thickening of the media and numerous large electron dense deposits located between the media and adventitia. Patients were homozygous for theNIT1c.727C>T; p.Arg243Trp variant or compound heterozygous for theNIT1c.727C>T; p.Arg243Trp and c.198_199del, p.Ala68* variant. Urine analysis showed increased levels of deaminated gluthatione, consistent with loss of NIT1 function in both homozygous and compound heterozygous patients. Based onNIT1carrier frequencies in UK Biobank and gnomAD, an estimated minimum of 4500 individuals worldwide are affected with this novel, autosomal recessively inherited cause of intracerebral haemorrhage, which we term NIT1-small vessel disease.
Viral rebound among patients receiving COVID-19 convalescent plasma for treatment of Covid-19 in Uganda
Authors: Alupo Patricia , Muttamba Winters , Mugenyi Levi , Kimuli Ivan , Winceslaus Katagira , Kirenga Bruce
Published: May 2023

Background

Viral rebound has been reported in people infected with COVID-19 treated with nirmatrelvir/ritonavir, and some cases been reported in patients who did not receive any antiviral treatment. Since the course of COVID-19 has not yet been well defined, we evaluated the incidence of viral rebound among COVID-19 patients treated with COVID-19 Convalescent Plasma (CCP) in Uganda.

Methods

In the CCP trail, 136 patients were enrolled between 21stSeptember 2020 and 2ndDecember 2020 who presented to the Mulago National Referral COVID-19 treatment unit. Patients with a positive SARS-CoV-2 reverse transcriptase (RT)-PCR test irrespective of disease severity were hospitalised and randomised to receive either COVID-19 CCP plus standard of care (SOC) or SOC alone. SARS-CoV-2 RT-PCR was done at baseline and on days 3, 5, 7, 14 and 28 post randomisation or until two consecutive negative RT-PCR results were obtained, whichever occurred first. We analysed for occurrence of viral rebound. Viral rebound was defined as a positive SARS-CoV-2 RT-PCR test following a prior negative test.

Findings

20% of the participants had viral rebound. Viral rebounders were predominantly male. The median age was 45-64 years and they had at least one co-morbidity. There was no difference in the rebound rates in the study arms, and participants with hypertension had more rebound rates compared to those with other co-morbidities.

Interpretation

Viral RNA rebound was common among patients receiving CCP. Viral rebound may be a result of the biphasic nature of COVID-19 infection, and not a consequence of the therapeutic interventions.
Prescribing pre- and post-operative physical activity interventions for people undergoing breast cancer surgery: a qualitative systematic review
Authors: Howe Lauren , Husband Andy , Robinson-Barella Anna
Published: May 2023

Introduction

Undertaking physical activity, pre- and post-operatively, can benefit recovery time and improve post-surgical outcomes. One cohort of patients that have reported these benefits are those undergoing surgery for breast cancer. Yet, what remains unclear is the level to which physical activity interventions are implemented into standard surgical care for patients with breast cancer.

Aims

This systematic review aimed to examine existing qualitative evidence focusing on pre- and post-operative physical activity interventions to better understand the benefits and shortcomings of physical activity within the surgical journey.

Methods

A systematic literature search was undertaken in November 2022, across five databases: MEDLINE, PsycINFO, Embase, CINAHL and Scopus. Qualitative studies involving people with breast cancer who had undertaken a physical activity intervention, either pre- and/or post-operatively, were included for analysis. The review was registered on PROSPERO: CRD42022372466 and performed according to PRISMA guidelines. The Critical Appraisal Skills Programme qualitative study checklist was used to assess study quality.

Results

Fourteen studies were included, comprising the perspectives of 418 people receiving surgery for breast cancer. One study implemented pre-operative physical activity interventions; the remaining studies focused on post-operative interventions. A narrative systematic review was undertaken due to heterogeneity in reported results. Four themes were developed by thematic analysis, centring on: (i) factors promoting engagement with physical activity interventions; (ii) factors preventing engagement with physical activity interventions; (iii) the impact of pre- and post-operative interventions on physical and psychological health; and (iii) participant recommendations for pre- and post-operative interventions.

Conclusion

pre- and post-operative physical activity interventions were well-accepted. Patients recognised factors which promoted or prevented engagement with interventions, as well as pre- and post-operative physical and psychological benefits that arose as a result. Evidence based co-design studies may further inform successful implementation of physical activity into standard care for surgical breast cancer patients.
Predicting the public health impact of bivalent vaccines and nirmatrelvir-ritonavir against COVID-19
Authors: Park Hailey J. , Tan Sophia T. , León Tomás M. , Jain Seema , Schechter Robert , Lo Nathan C.
Published: May 2023

Background

Uptake of COVID-19 bivalent vaccines and oral medication nirmatrelvir-ritonavir (Paxlovid) has remained low across the United States. Assessing the public health impact of increasing uptake of these interventions in key risk groups can guide further public health resources and policy.

Methods

This modeling study used person-level data from the California Department of Public Health on COVID-19 cases, hospitalizations, deaths, and vaccine administration from July 23, 2022 to January 23, 2023. We modeled the impact of additional uptake of bivalent COVID-19 vaccines and nirmatrelvir-ritonavir during acute illness in different risk groups defined by age (50+, 65+, 75+ years) and vaccination status (everyone, primary series only, previously vaccinated). We predicted the number of averted COVID-19 cases, hospitalizations, and deaths and number needed to treat (NNT).

Results

For both bivalent vaccines and nirmatrelvir-ritonavir, the most efficient strategy (based on NNT) for averting severe COVID-19 was targeting the 75+ years group. We predicted that perfect coverage of bivalent boosters in the 75+ years group would avert 3,920 hospitalizations (95%UI: 2,491-4,882; 7.8% total averted; NNT 387) and 1,074 deaths (95%UI: 774-1,355; 16.2% total averted; NNT 1,410). Perfect uptake of nirmatrelvir-ritonavir in the 75+ years group would avert 5,644 hospitalizations (95%UI: 3,947-6,826; 11.2% total averted; NNT 11) and 1,669 deaths (95%UI: 1,053-2,038; 25.2% total averted; NNT 35).

Conclusions

These findings suggest prioritizing uptake of bivalent boosters and nirmatrelvir-ritonavir among the oldest age groups would be efficient and have substantial public health impact in reducing the burden of severe COVID-19, but would not address the entire burden of severe COVID-19.
Group comparison based on genetic information reveals lineage-specific therapeutic vulnerabilities in acute myeloid leukemia
Authors: Nakahara Jakushin , Yamamoto Keita , Yabushita Tomohiro , Chinen Takumi , Ito Kei , Takeda Yutaka , Kitagawa Daiju , Goyama Susumu
Published: May 2023

Cancer is a genetic disease with specific mutations or fusions. Therapies targeting cancer cell-specific essential genes are expected to have efficient anticancer effects with fewer side effects. To explore such cancer cell-specific vulnerabilities, we established a two-group comparison system to predict essential genes in each cancer subtype using the data from the Cancer Dependency Map (DepMap). We applied this analytical method to acute myeloid leukemia (AML) and identified PCYT1A and BCL2L1 as a specific vulnerability in MLL-rearranged AML andTP53-mutated AML, respectively. Interestingly, further investigation revealed that PCYT1A is in fact a critical regulator in monocytic AML including those with MLL-rearrangements, and BCL2L1 is essential in acute erythroid leukemia in whichTP53is frequently mutated. These results highlighted the importance of cell of origin, rather than the genetic aberrations alone, to identify subtype-specific vulnerabilities in AML. The DepMap-based two-group comparison approach could accelerate the discovery of subtype-specific therapeutic targets in diverse cancers.