bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tu Puedes—An Exploratory Usability Pilot of a Postpartum Education "App" for Latina Women with Previous Gestational Diabetes
Authors: CASTORINO KRISTIN , ALVAREZ SILVIA , MATHERS HANNAH M. , LAREZ ARIANNA J. , AXELROD CEARA 
Published: June 2018

Gestational diabetes mellitus (GDM) affects nearly 14% of Latina women—a rate significantly higher than the background population. Standard-of-care dictates that postpartum education should be provided though it is rarely done due to socioeconomic, linguistic, transportation and childcare barriers. We propose that a smartphone application (app) has the potential to serve as a cost-effective approach to delivering health education that can break through these barriers and empower postpartum Latina women with the education requisite for making positive lifestyle changes. We designed a small pilot study to test the app’s usability to inform larger studies. Tu Puedes is a culturally and linguistically appropriate diabetes prevention app we developed in Spanish. Women with previous GDM aged 18-40 years completed 4 lessons, either though the app or via an in-person classroom setting with a scripted curriculum. A pre- and post-survey was given to assess participants’ qualitative experience using the app. In addition, standard metabolic measures at baseline and post-intervention (4 weeks) were completed, and compared for both groups. Of the 22 women recruited, 17 completed all 4 lessons, with greater retention in the app group. Survey responses were overall positive, with 73% of participants deeming the app both easy to use and better than any past group education. Users had a 40% increase in self-perceived health, 67% of users wanted to continue use of the app, and all users would recommend it to a friend. Though insufficiently powered and for nominal duration, we found significant decreases in weight and BMI compared to the control group with 90% and 95% confidence respectively, but not in blood pressure or waist circumference. Our results suggest that the Tu Puedes app is a feasible and user-friendly way to disseminate postpartum diabetes prevention education to a Spanish-speaking Latina population with previous GDM, and support the need for further research.

Disclosure
K. Castorino: None. S. Alvarez: None. H.M. Mathers: None. A.J. Larez: None. C. Axelrod: None.
Effect of Dairy Consumption and Its Fat Content on Glycemic Control and Cardiovascular Risk Factors in Patients with Type 2 Diabetes—A Randomized Controlled Study
Authors: MOTTALIB ADHAM , MITRI JOANNA , SALSBERG VERONICA , ASHRAFZADEH SAHAR , ELSEAIDY TAHA , TOMAH SHAHEEN , ALSIBAI KHALED , MAHMOUD NOOR , HAMDY OSAMA 
Published: June 2018

The 2015 Dietary Guidelines for Americans recommend daily consumption of 3 servings of low or non-fat dairy. However, the effects of dairy consumption and its fat content on glycemic control and cardiovascular risk factors in patients with type 2 diabetes (T2D) are unknown. This study was designed to evaluate the impact of higher consumption of full-fat and low/non-fat dairy on HbA1c, lipid profile and blood pressure (BP) in patients with T2D.
We enrolled 72 participants with uncontrolled T2D (mean age 59±8 years, 46% females) who were consuming &lt;3 servings of dairy/day and randomized them into 3 groups. Group A was asked to incorporate ≥3 daily servings of full-fat dairy and group B to incorporate ≥3 daily servings of low/ non-fat dairy into their diet. Group C was asked to maintain the baseline dairy intake. Participants were counseled by a registered dietitian about maintaining their daily caloric intake and body weight. They were asked to maintain their usual doses of diabetes, antihypertensive and hypolipidemic medications. Participants were evaluated at baseline, 3 and 6 months.
At baseline, mean T2D duration was 14±8 years, HbA1c 8.1±1.0%, body weight 92±17 kg, daily caloric intake 1885±600 kcal (43.4±7.0% carbohydrates, 37.8±5.5% fat, 13.0±2.8% saturated fat, and 18.1±3.6% protein), LDL-C 80±26 mg/dL, HDL-C 47±16 mg/dL, triglycerides 172±178 mg/dL, systolic BP 129±16 mmHg and diastolic BP 72±8 mmHg. There were no differences between groups in any of these parameters at baseline. At 6 months, percent calories from saturated fat increased by 3.7±0.8% in group A (p&lt;0.0001), and decreased by 4.4±1.7% in group B (p=0.014). There were no differences in HbA1c, body weight, total caloric intake or percent calories from carbohydrates, lipid parameters or BP between groups.
This study shows that increasing consumption of dairy products to ≥3 servings/day, irrespective of fat content, has no effect on HbA1c, lipid profile or BP in patients with T2D.

Disclosure
A. Mottalib: None. J. Mitri: Research Support; Self; National Dairy Council, Kowa Pharmaceuticals America, Inc.. Research Support; Spouse/Partner; AbbVie Inc., Janssen Pharmaceuticals, Inc., Takeda Pharmaceuticals U.S.A., Inc., Gilead Sciences, Inc.. Consultant; Spouse/Partner; Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Biogen, AbbVie Inc.. V. Salsberg: None. S. Ashrafzadeh: None. T. Elseaidy: None. S. Tomah: None. K. Alsibai: None. N. Mahmoud: None. O. Hamdy: Research Support; Self; Abbott. Advisory Panel; Self; AstraZeneca. Consultant; Self; Merck & Co., Inc.. Research Support; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Healthimation, LLC.. Consultant; Self; Sanofi-Aventis.
MEDI0382, a GLP/Glucagon Receptor Dual Agonist, Significantly Reduces Hepatic Fat Content in Subjects with Type 2 Diabetes Mellitus
Authors: JAIN MEENA , TSAI LAN-FENG , ROBERTSON DARREN , HIRSHBERG BOAZ , HOCKINGS PAUL , JOHANSSON LARS , AMBERY PHILIP 
Published: June 2018

MEDI0382 is a balanced GLP-1/glucagon receptor dual agonist in development for type 2 diabetes mellitus (T2DM). We investigated the effects of MEDI0382 on hepatic fat content in overweight/obese subjects with T2DM and a BMI of 27-40 kg/m2. In a phase 2a study (NCT02548585), 51 subjects were randomized to receive MEDI0382 200 μg or placebo daily during a 41-day treatment period. Quantification of liver proton density fat fraction, subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) was performed as an exploratory analysis in a subset of patients (MEDI0382 n = 17, placebo n = 21) who had MRI scans taken at baseline and day 41. Mean (SD) liver fat content at baseline was 15.7% (8.97) and 18.1% (8.38) in the MEDI0382 and placebo groups, respectively. Patients treated with MEDI0382 showed a highly significant relative reduction from baseline in hepatic fat content vs. placebo (Table). This was positively correlated with reductions in both body weight (r = 0.49, P = 0.002) and alanine aminotransferase (r = 0.42, P = 0.009). Treatment with MEDI0382 was also associated with reductions in both SAT and VAT vs. placebo. These data demonstrate the efficacy of MEDI0382 in reducing liver fat and its potential for the treatment of nonalcoholic fatty liver disease, including steatohepatitis.MeasurementChange from Baseline, LS Mean (90% CI)P MEDI0382 (n - 17)Placebo (n = 21)Hepatic fat content, absolute change (%)-5.98 (-7.67, -4.29)-3.17 (-4.68, -1.65)0.017Hepatic fat content, relative change (%)-39.12 (49.11, -29.14)-19.51 (-28.49, -10.53)0.006SAT (L)-0.39 (-0.48, -0.30)-0.21 (-0.30, -0.13)0.008VAT (L)-0.36 (-0.52, -0.19)-0.14 (-0.29, 0.01)0.057

Disclosure
M. Jain: Employee; Self; MedImmune. L. Tsai: Employee; Self; MedImmune. D. Robertson: Employee; Self; MedImmune. Employee; Spouse/Partner; GlaxoSmithKline plc. B. Hirshberg: Employee; Self; AstraZeneca, MedImmune. P. Hockings: Other Relationship; Self; MedImmune, AstraZeneca. L. Johansson: Stock/Shareholder; Self; Antaros Medical. P. Ambery: Employee; Self; MedImmune. Stock/Shareholder; Self; AstraZeneca.
Excess Nicotinamide Induces Reactive Oxygen Species Generation, Insulin Resistance, and Epigenetic Change in Rats and Humans
Authors: ZHOU YIMING , CHEN NANA , LI DA , SUN WUPING , ZHOU SHI-SHENG 
Published: June 2018

The implementation of grain fortification with niacin, commonly in the form of nicotinamide, has significantly increased niacin per capita consumption in U.S. from 1930s. Nicotinamide is the precursor of NAD and NADP, which participate in many biological reactions. Therefore, nicotinamide homeostasis is vitally important for the body. This study is to investigate the effects of excess nicotinamide on ROS generation, insulin resistance, and epigenetic change, which are hallmarks of type 2 diabetes.
We found acute nicotinamide overload increased ROS generation, insulin resistance, and reduced muscle glycogen level in adult rats. Besides these effects, long-term nicotinamide overload led to oxidative stress in kidney and liver, increased their DNA damage, and decreased their global DNA methylation profile. We further demonstrated that decreasing nicotinamide degradation and excretion level was crucial for the ROS generation- and insulin resistance-inducing effects using an impaired skin detoxification rat model.
Using oral glucose tolerance test (OGTT), we observed that in healthy volunteers, nicotinamide addition induced higher levels of ROS generation and insulin resistance in the early phase, followed by hypoglycemia in the late phase. Compared to controls, diabetic patients showed a disturbed nicotinamide degradation pattern, characterized by higher plasma N1-methylnicotinamide (NMN) levels and lower urinary degraded metabolite, N1-methyl-2-pyridone-5-carboxamide (2-Py).
Mechanistically nicotinamide degradation process was associated with ROS generation; excess nicotinamide led to higher ROS generation causing kidney and liver damage. We also found that excess nicotinamide disturbed the monoamine neurotransmitters degradation and DNA methylation by competing for the biological methyl-donor, betaine in the body.
In summary, our results indicate that excess nicotinamide may play an important role in type 2 diabetes.

Disclosure
Y. Zhou: None. N. Chen: None. D. Li: None. W. Sun: None. S. Zhou: None.
Effect of Stevia on Glycemic and Insulin Responses in Obese Patients—A Randomized, Double-Blind, Placebo-Controlled Crossover Study
Authors: SAMAKKARNTHAI PARINYA , PAYANUNDANA MANAPORN , SATHAVARODOM NATTAPOL , SIRIWAN CHONPITI , BOONYAVARAKUL APUSSANEE 
Published: June 2018

Background: Stevia is natural nonnutritive sweeteners (NNS) that is considered to be metabolic inert in contrast with artificial NNS, especially sucralose, which cause glucose intolerant in obese patients. However, acute effect of stevia ingestion on glycemic and insulin responses in obese patients are not clearly established.
Objectives:To assess acute effect of stevia on glycemic and insulin responses in obese patients.
Material and Methods: Obese patients underwent a 75 gram oral glucose tolerance test (OGTT) preceded by consuming pills containing either 200 mg stevia or placebo for 60 minutes before test on two separate occasions, 1 week apart, in a randomized crossover design. Blood samples were obtained for glucose and insulin at 0,30,60,90 and 120 minutes. Area under the curve (AUC) of glucose and insulin responses were calculated. Indices for insulin sensitivity (Matsuda index) and Insulin secretion (Insulinogenic index) were calculated using minimal models of glucose and insulin kinetics.
Results: Twenty obese patients (BMI 28.75±3.68 kg/m2) were recruited to the study. There were no significant differences in AUC of glucose and insulin between stevia and placebo (glucose, 15,285±4,531 vs. 15,101 ±3,955, p=0.89 and insulin 8,507 ±5,858 vs. 7,652 ± 5,020,p=0.62) Insulin sensitivity derived from OGTT using Matsuda index was not significant difference between stevia and placebo (4.74±1.86 vs. 5.84±2.96,p=0.09). Insulin secretion using Insulinogenic index was not significant difference between stevia and placebo (p=0.155).
Conclusions: Stevia does not affect in acute glycemic and insulin responses to OGTT in obese patients. This findings need to be determined in longer duration of ingestion study.

Disclosure
P. Samakkarnthai: None. M. Payanundana: None. N. Sathavarodom: None. C. Siriwan: None. A. Boonyavarakul: None.
Mir-128 Targets Thioredoxin-Interacting Protein 3’UTR and Downregulates Its Expression in Pancreatic Beta Cells
Authors: JING GU , CHEN JUNQIN , XU GUANLAN , SHALEV ANATH 
Published: June 2018

Thioredoxin-interacting protein (TXNIP) expression is induced by glucose, promotes beta cell apoptosis and is essential for glucotoxicity-induced beta cell death, whereas TXNIP deficiency protects against diabetes. Carbohydrate-response element-binding protein (ChREBP/MondoA) is the major transcription factor conferring glucose-induced TXNIP expression. However, we recently discovered that glucose was still able to induce TXNIP in ChREBP knockout mouse islets suggesting the existence of other factors involved in glucose-induced TXNIP regulation. Analyses of the TXNIP 3’UTR revealed several potential miRNA binding sites including miR-93, miR-106b and miR-128. However, using INS-1 beta cells, primary mouse islets and T2D human islets, we found that only miR-128 was downregulated by glucose or diabetes. This suggested that glucose might decrease miR-128 and thereby promote TXNIP expression. In fact, we found overexpression of miR-128 significantly reduced TXNIP mRNA and protein expression whereas inhibition of miR-128 increased beta cell TXNIP expression. Furthermore, luciferase assays using reporter constructs with the wild type TXNIP 3’UTR or a mutated TXNIP 3’UTR confirmed that TXNIP is indeed a direct target of miR-128. Taken together, the results of these studies have identified a novel microRNA directly targeting TXNIP and revealed an alternative, post-transcriptional pathway by which glucose induces TXNIP expression.

Disclosure
G. Jing: None. J. Chen: None. G. Xu: None. A. Shalev: None.
Evidence for Necroptosis as a Mechanism of Islet Amyloid–Induced Beta-Cell Death
Authors: TEMPLIN ANDREW T. , HOGAN MEGHAN F. , ESSER NATHALIE , ZRAIKA SAKENEH , HULL REBECCA L. , KAHN STEVEN E. 
Published: June 2018

Islet amyloid deposition occurs in the majority of individuals with type 2 diabetes (T2D) and contributes to beta-cell death by mechanisms which are not fully understood. Necroptosis is an immunogenic form of cell death dependent on tumor necrosis factor receptor 1 (TNFR1) signaling, receptor interacting protein kinase 3 (RIPK3) oligomerization, and mixed lineage kinase domain-like (MLKL) phosphorylation. We previously showed mRNA and protein levels of TNFa, a TNFR1 ligand, are increased in islets by amyloid deposition in vitro and in vivo, raising the possibility that amyloid formation induces necroptosis. Thus, we sought to determine whether the components of necroptosis are present in beta cells, and if islet amyloid-induced TNFa expression elicits beta-cell necroptosis. We observed protein expression of TNFR1, RIPK3, and MLKL in the INS-1 beta-cell line, indicating necroptosis components are present in beta cells. In human islet amyloid polypeptide (hIAPP) transgenic mouse islets cultured in 16.7 mM glucose, an in vitro model of islet amyloidosis, we found necroptosis signaling to be increased compared to amyloid-free wild type (WT) islets. This manifested as increased oligomerization of RIPK3 protein (trimers: 2.7 ± 0.2 [hIAPP] vs. 1.0 [WT], n=3, p&lt;0.01) and phosphorylation of the RIPK3 target MLKL (1.8 ± 0.3 vs. 1.0, n=3, p=0.06), without a change in TNFR1 protein expression (1.1 ± 0.1 vs. 1.0, n=2, p=0.74). As further support that amyloid induces immunogenic cell death, immune cell mRNA abundance was increased in vivo in amyloid containing hIAPP transgenic islets vs. WT islets (macrophages: Emr1, 1.6 ± 0.2 [hIAPP] vs. 1.1 ± 0.1 [WT], n=4, p=0.04, T cells: Cd3, 2.7 ± 0.5 vs. 1.0 ± 0.2, n=4, p=0.03, and B cells: Cd20, 2.3 ± 0.2 vs. 1.2 ± 0.5, n=2, p=0.17). These data suggest that necroptosis may be a previously unrecognized mechanism of beta-cell death in response to islet amyloid formation. Further studies are needed to determine whether inhibition of necroptosis signaling may reduce beta-cell death in T2D.

Disclosure
A.T. Templin: None. M.F. Hogan: None. N. Esser: None. S. Zraika: None. R.L. Hull: Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company. S.E. Kahn: Advisory Panel; Self; Boehringer Ingelheim GmbH, Elcelyx Therapeutics, Inc., Eli Lilly and Company, Intarcia Therapeutics, Inc., Janssen Research & Development, Merck & Co., Inc., Novo Nordisk A/S.
Positive Impact of Integrative Medicine Approaches on Diabetes Related Care
Authors: KU JEONG-HEE , FREEBY MATTHEW , MULLUR RASHMI S. 
Published: June 2018

Patients with diabetes have higher prevalence of depression and diabetes-related distress that negatively impacts care. Mindfulness-based approaches have shown to improve depression, diabetes-related distress, and in small studies also improve glycemic outcomes. We created a 90-minute, shared medical appointment; led by an endocrinologist, teaching patients integrative approaches to manage diabetes- related distress. We included patients with type 2 diabetes referred by a primary care provider or an endocrinologist, and assessed Diabetes Distress Scale (DDS), Patient Health Questionnaire-9 (PHQ-9) as well as Hemoglobin A1C (HbA1C), weight, blood pressure (BP), heart rate (HR) before the group visit.
Thirty-four patients attended group sessions, with mean age of 63.9 years, mean baseline HbA1C 7.7% and mean BMI 33.3. The mean DDS was 36.2, and mean PHQ-9 was 7.8. Twenty-four patients followed up in clinic 3 months after initial appointment and showed mean reduction in HbA1C by 0.18% (p=0.35). Subgroup analysis of patients with baseline HbA1C ≥ 7.5% (n=11) showed mean reduction in HbA1C by 0.8% (p=0.005). No statistically significant changes in BP, HR or weight were seen, while a subgroup of patients with baseline A1C ≥7.5% had non-statistically significant mean weight loss of 1.3kg. This retrospective study of a mindfulness-based approach suggests positive clinical impact and need for a larger, randomized trial.
Table 1. Baseline characteristics, change in parameters 3 months after interventionBaseline characteristicsTotal patients who attended (N=34)Patients with 3 months follow up (n=24)Subgroup with baseline HbA1C ≥7.5 (n=11)Mean age in years (SD)63.9 (10.2)65.2 (9.7)64.6 (10.9)% Women67.60%66.70%72.70%Mean body weight, kg (SD)94.3 (22.8)90.2 (16.6)91.7 (17.5)Mean BMI (SD)33.3 (7.2)31.9 (5.54)31.8 (6.0)Mean HgbA1C, % (SD)7.7 (1.3)7.5 (1.2)8.5 (0.9)Mean DDS (SD)36.2 (13.7)35.7 (14.3)35.9 (15.8)Mean PHQ-9 (SD)7.8 (5.2)7.4 (5.8)7.1 (6.7)Change in HbA1C from baseline to 3 months- 0.15 % (p=0.35)- 0.8 % (p=0.005)Change in weight from baseline to 3 months- 0.4 kg (p=0.48)- 1.3kg (p=0.17)

Disclosure
J. Ku: None. M. Freeby: None. R.S. Mullur: None.
Associations between A1C and Continuous Glucose Monitoring–Derived Glycemic Parameters
Authors: CALHOUN PETER , JOHNSON TERRI , WELSH JOHN , WALKER TOMAS C. , PRICE DAVID A. 
Published: June 2018

The percentage of continuous glucose monitoring (CGM)-derived sensor glucose (SG) values in the 70-180 mg/dL range (time in range [TIR]) is an important outcome for patients and their clinicians; however, consensus TIR goals are lacking. This study aimed to characterize associations between CGM-derived glycemic metrics and A1C in 4 clinical trials: DIAMOND Phase 1 (N=104), DIAMOND Phase 2 (N=69), REPLACE-BG (N=216), and HypoDE (N=141). Each study lasted ≥24 weeks, used current-generation CGM systems (Dexcom, Inc.), and included comparisons of central-lab end-of-study A1C to CGM data during the preceding 3 mo. Data from 530 adults with diabetes (455 type 1) were analyzed. The Figure shows mean SG (MSG), TIR, time &lt;70, &lt;54, and &gt;250 mg/dL for individuals in 6 A1C bins. Higher A1C bins were associated with higher MSG and lower TIR; lower A1C bins were associated with lower MSG and higher TIR. For subjects with A1C &lt;7.0%, median TIR was 72%, with 90% of subjects having TIR &gt;57%. Median time with SG &lt;54 mg/dL was &lt;20 min/day for all A1C bins, but median time with SG &gt;250 mg/dL increased from 0.6 h/day to 6.7 h/day across bins. For subjects with A1C ≥8.0%, median TIR was 44%, with 90% of the subjects having TIR &lt;59%. In CGM users, low A1C values can be achieved with minimal additional exposure to very low SG values. The observed associations between TIR and A1C may help clinicians and patients establish appropriate TIR goals.

Disclosure
P. Calhoun: Employee; Self; Dexcom, Inc.. Stock/Shareholder; Self; Dexcom, Inc.T. Johnson: Employee; Self; Dexcom, Inc.J. Welsh: Employee; Self; Dexcom, Inc.. Stock/Shareholder; Self; Dexcom, Inc., Medtronic. T.C. Walker: Employee; Self; Dexcom, Inc.D.A. Price: Employee; Self; Dexcom, Inc..
Evaluointi opettajan vuorovaikutustoimintana
Authors: Heinonen Pilvi 
Published: June 2018

Pilvi Heinosen suomen kielen alaan kuuluva väitöskirja tarkastettiin Helsingin yliopistossa 16. joulukuuta 2017. Vastaväittäjänä toimi dosentti Mia Halonen Jyväskylän yliopistosta ja kustoksena professori Marja-Leena Sorjonen.
Pilvi Heinonen: Evaluointi opettajan vuorovaikutustoimintana: osallistujuuden ulottuvuudet luokkahuoneessa. Helsinki: Helsingin yliopisto 2017.
Väitöskirja on luettavissa osoitteessa https://helda.helsinki.fi/handle/10138/228394.
Geology Of Tanjung Medan ,Rokan IV Koto , Rokan Hulu District, Riau Province
Authors: Prayitno Budi , Susilo Susilo 
Published: June 2018

The Administrative of research area has been in Tanjung Medan, Rokan IV Koto, Rokan Hulu, Riau Province and geographically located at 0 ° 37 '28.488 "- 0 ° 40' 10.3692" LU and 100 ° 24 '55.6884 "- 100 ° 27 '37.5804 "BT. Research method used approach method and laboratory analysis to get data of geology modeling and re-construction of geological history in research area. Based on surface observation, the geology of research area consists of Slate (Permian-carbon), Granite intrusion (Permian-Trias) with distribution SouthWest-SouthEast on the center of map. Arenite Sandstone unit (Easly Eocene) unconformity with slate on the bottom. Alluvial Rokan river crosses all type off rocks from north to south of map. While structure growth in the research area have been joints structure with main stress Southwest-NorthEast, its similar with trend tectonic setting of Sumatra island, on the other hand reverse fault indicates the formation of a basin of extension stress in the early Eocene. the formation of basins in basement rocks begun at the time of the formation of the north-south trending northern form of the fault block forming horst and graben as well as accommodated the precipitation of pre-tertiary clastic materials. Whereas the Oligocene trans-tensional compression system accommodating the sedimentation system in the formed of arenite sandstone (SBPa) unconformity above the basement rocks simultaneously on the basin base decrease. The distribution of arenite sandstones based on the geological reconstruction covering all parts of the rock distribution which then undergoes the same weathering process of the formation of Bukit Barisan volcanic path that controls the development of geological structure up to the present.
The Impact of the European Union on Cultural Policy in Malta
Authors: Xuereb Karsten 
Published: June 2018

Abstract
This paper will address the impact of the European Union (EU) on cultural policy development in Malta. The attention paid by the EU to globalising matters through culture, particularly i) citizenship participation in relation to social integration, ii) economic revival through urban regeneration, and iii) cultural diplomacy with regard to internationalisation efforts, is acknowledged and assessed through a focus on recent Maltese cultural practice. Impact will be assessed in relation to a) policy as well as legislation, b) funding structures and incentives, and c) implementation measures through initiatives taken by Maltese public cultural institutions. Convergences and divergences in comparison with key EU strategic actions will be discussed, with reference made to major legislative documents, funding programmes, and cultural projects undertaken by Maltese authorities and other cultural stakeholders in response or in relation to European developments.