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Abstract Background Surfactant is a well-established therapy for preterm neonates affected by respiratory distress syndrome (RDS). The goals of different methods of surfactant administration are to reduce the duration of mechanical ventilation and the severity of bronchopulmonary dysplasia (BPD); however, the optimal administration method remains unknown. This study compares the effectiveness of the INtubate-RECruit-SURfactant-Extubate (IN-REC-SUR-E) technique with the less-invasive surfactant administration (LISA) technique, in increasing BPD-free survival of preterm infants. This is an international unblinded multicenter randomized controlled study in which preterm infants will be randomized into two groups to receive IN-REC-SUR-E or LISA surfactant administration. Methods In this study, 382 infants born at 24+0–27+6 weeks’ gestation, not intubated in the delivery room and failing nasal continuous positive airway pressure (nCPAP) or nasal intermittent positive pressure ventilation (NIPPV) during the first 24 h of life, will be randomized 1:1 to receive IN-REC-SUR-E or LISA surfactant administration. The primary outcome is a composite outcome of death or BPD at 36 weeks’ postmenstrual age. The secondary outcomes are BPD at 36 weeks’ postmenstrual age; death; pulse oximetry/fraction of inspired oxygen; severe intraventricular hemorrhage; pneumothorax; duration of respiratory support and oxygen therapy; pulmonary hemorrhage; patent ductus arteriosus undergoing treatment; percentage of infants receiving more doses of surfactant; periventricular leukomalacia, severe retinopathy of prematurity, necrotizing enterocolitis, sepsis; total in-hospital stay; systemic postnatal steroids; neurodevelopmental outcomes; and respiratory function testing at 24 months of age. Randomization will be centrally provided using both stratification and permuted blocks with random block sizes and block order. Stratification factors will include center and gestational age (24+0 to 25+6 weeks or 26+0 to 27+6 weeks). Analyses will be conducted in both intention-to-treat and per-protocol populations, utilizing a log-binomial regression model that corrects for stratification factors to estimate the adjusted relative risk (RR). Discussion This trial is designed to provide robust data on the best method of surfactant administration in spontaneously breathing preterm infants born at 24+0–27+6 weeks’ gestation affected by RDS and failing nCPAP or NIPPV during the first 24 h of life, comparing IN-REC-SUR-E to LISA technique, in increasing BPD-free survival at 36 weeks’ postmenstrual age of life. Trial registration ClinicalTrials.gov NCT05711966. Registered on February 3, 2023.

Respiratory health in children is essential for general wellbeing and healthy development in the short and long term. It is well known that many respiratory diseases in adulthood have their origins in early life, and therefore research on prevention of respiratory diseases and management of children with respiratory diseases will benefit patients during the full life course. Scientific and clinical advances in the field of respiratory health are moving at a fast pace. This article summarises some of the highlights in paediatric respiratory medicine presented at the hybrid European Respiratory Society (ERS) International Congress 2023 which took place in Milan (Italy). Selected sessions are summarised by Early Career Members of the Paediatrics Assembly (Assembly 7) under the supervision of senior ERS officers, and cover a wide range of research areas in children, including respiratory physiology and sleep, asthma and allergy, cystic fibrosis, respiratory infection and immunology, neonatology and intensive care, respiratory epidemiology and bronchology.

Abstract Background Malaria caused by Plasmodium falciparum is one of the leading causes of human morbidity and mortality from infectious diseases, predominantly in tropical and sub-tropical countries. As genetic variations in the toll-like receptors (TLRs)-signalling pathway have been associated with either susceptibility or resistance to several infectious and inflammatory diseases, the supposition is that single nucleotide polymorphisms (SNPs) of TLR2, TLR4, TLR9, Toll-interleukin 1 receptor domain containing adaptor protein (TIRAP) and FCGR2A could modulate malaria susceptibility and severity. Methods This study was planned to make a further contribution to solving the problem of the real role of the most common polymorphisms of TLR4, TLR9, TIRAP and FCGR2A genes in modulating the risk of malaria and disease severity in children from Burundi, Central Africa. All the paediatric patients aged six months to 10 years admitted to the hospital of Kiremba, Burundi, between February 2011 and September 2011, for fever and suspicion of acute malaria were screened for malaria parasitaemia by light microscopy of thick and thin blood smears. In children with malaria and in uninfected controls enrolled during the study period in the same hospital, blood samples were obtained on filter paper and TLR4 Asp299Gly rs4986790, TLR9 G1174A rs352139, T-1486 C rs187084 TLR9 T-1237 C rs5743836, TIRAP Ser180Leu rs8177374 and the FCGR2A His131Arg rs1801274 polymorphisms were studied using an ABI PRISM 7900 HT Fast Real-time instrument. Results A total of 602 patients and 337 controls were enrolled. Among the malaria cases, 553 (91.9 %) were considered as suffering from uncomplicated and 49 (8.1 %) from severe malaria. TLR9 T1237C rs5743836CC was associated with an increased risk of developing malaria (p = 0.03), although it was found with the same frequency in uncomplicated and severe malaria cases. No other differences were found in all alleles studied and in genotype frequencies between malaria cases and uninfected controls as well as between uncomplicated and severe malaria cases. Conclusions TLR9 T1237C seems to condition susceptibility to malaria in Burundian children but not its severity, whereas none of the assessed SNPs of TLR4, TIRAP and FCGR2A seem to influence susceptibility to malaria and disease severity in this population.

Since the beginning of the pandemic, while progressive movements have mainly focused on social inequalities exacerbated by the sanitary emergency, a number of protests emerged and quickly became visible that initially targeted the policies taken to reduce contagion and subsequently focused on the vaccine and vaccination. In the attempt to account for the rapid development of these protests, social scientists have mostly turned to classical approaches used in the analysis of far-right organizations and sects, looking at broad transformations in society or at fear and a sense of insecurity at the individual level. In this article, we build upon a social movement approach to look at the main characteristics of the protests against anti-contagion measures. From a theoretical point of view, we point to the importance of disentangling the specific waves happening within broader protest cycles. Empirically, focusing on the Italian case, we present a novel development in protest event analysis looking at the specific forms of action, the actors involved, and their claims in two waves of contention during the pandemic in Italy, between 2020 and 2021.

A new methodology to improve the sensitivity to new physics contributions to the Standard Model processes at LHC is presented. A Variational AutoEncoder trained on Standard Model processes is used to identify Effective Field Theory contributions as anomalies. While the output of the model is supposed to be very similar to the inputs for Standard Model events, it is expected to deviate significantly for events generated through new physics processes. The reconstruction loss can then be used to select a signal enriched region which is by construction independent of the nature of the chosen new physics process. In order to improve further the discrimination power, an adversarial layer is introduced with a cross entropy term added to the loss function, optimizing at the same time the reconstruction of the input variables of the Standard Model and classification of new physics processes. This procedure ensures that the model is optimized for discrimination, with a small price in terms of model dependency to physics process. In this work I will discuss in detail the above-mentioned method using generator level Vector Boson Scattering events produced at LHC assuming an integrated luminosity of 350/fb.

This review has been prepared by the Early Career Members and Chairs of the European Respiratory Society (ERS) Assembly 7: Paediatrics. We here summarise the highlights of the advances in paediatric respiratory research presented at the ERS International Congress 2022. The eight scientific groups of this Assembly cover a wide range of research areas, including respiratory physiology and sleep, asthma and allergy, cystic fibrosis (CF), respiratory infection and immunology, neonatology and intensive care, respiratory epidemiology, bronchology, and lung and airway developmental biology. Specifically, we report on abstracts presented at the congress on the effect of high altitude on sleep, sleep disorders, the hypoxic challenge test, and measurements of ventilation inhomogeneity. We discuss prevention of preschool wheeze and asthma, and new asthma medications. In children with CF, we describe how to monitor the effect of CF transmembrane conductance regulator modulator therapy. We present respiratory manifestations and chronic lung disease associated with common variable immunodeficiency. Furthermore, we discuss how to monitor respiratory function in neonatal and paediatric intensive care units. In respiratory epidemiology, we present the latest news from population-based and clinical cohort studies. We also focus on innovative and interventional procedures for the paediatric airway, such as cryotherapy. Finally, we stress the importance of better understanding the molecular mechanisms underlying normal and abnormal lung development.

Since the outbreak of the Covid-19 pandemic, progressive social movements have been engaged in an incredibly intense period of contestation. Confronted with the unprecedented extent of the crisis, the current wave of mobilization brought together both older and newer actors, bridging generations and movement sectors, building on past experiences of previous mobilizations while also innovating in important ways. The Covid-19 pandemic provides an opportunity to contextualize the role of past mobilizations in contemporary struggles, singling out continuities and innovation in the forms of resistance, collective frames, and organizational models. This paper focuses on the framing of health rights and analyzes the emergence of care as a bridging frame in the movement campaigns developed during the Covid-19 crisis. In examining the processes of cross-temporal diffusion, it considers the legacy of the Global Justice Movement and its offspring in the current mobilization in Italy. Through the analysis of key documents produced by social movements triangulated with in-depth interviews with activists, we observe the ways in which some collective frames migrate from past mobilizations to new ones, and are adapted through the reactivation of old organizational networks and the emergence of new organizations. [ABSTRACT FROM AUTHOR]

The article examines the gender politics of populist parties in two countries historically marked by cultural traditionalism – Italy and Spain. It defines and compares the articulation of gender issues cross-nationally and intra-ideologically to understand how populist parties contest the politics of gender in the two countries. Drawing on computer-assisted qualitative content analyses of programmatic documents, it assesses the framing and salience of gender by the populist radical left (the Spanish Podemos) and right (Lega and Fratelli d'Italia in Italy; VOX in Spain), while also accounting for an ideologically ambiguous populist party (the Italian Movimento 5 Stelle). It concludes ascertaining the different salience of gender politics among Italian and Spanish populist parties and evinces multiple axes of programmatic proximity and distance – not only cross-nationally, but also intra-ideologically among parties akin. [ABSTRACT FROM AUTHOR]

Objective: Monitoring infants’ breathing activity is crucial in research and clinical applications but remains a challenge. This study aims to develop a contactless method to monitor breathing patterns and thoracoabdominal asynchronies in infants inside the incubator, using depth cameras. Methods: We proposed an algorithm to extract the 3D displacements of the ribcage and abdomen from the analysis of depth images. We evaluated the accuracy of the system in-vitro vs. a reference motion capture analyzer. We also conducted a feasibility study on 12 patients receiving non-invasive respiratory support to estimate the mean and the variability of the chest wall displacements in preterm infants and evaluate the suitability of the proposed system in the clinical setting. Results: In-vitro, the mean (95% CI) error in the measurement of amplitude, frequency and phase shift between compartmental displacements was −0.14 (−0.57, 0.28) mm, 0.02 (−0.99, 1.03) bpm, and −0.40 (−1.76, 0.95)°, respectively. In-vivo, the mean (95% CI) amplitude of the ribcage and abdomen displacements were 0.99 (0.34, 2.67) mm and 1.20 (0.40, 2.15) mm, respectively. Conclusions: The developed system proved accurate in-vitro and was suitable for the clinical environment. Clinical Impact: The proposed method has value for evaluating infants’ breathing patterns in research applications and, after further development, may represent a simple monitoring tool for infants’ respiratory activity inside the incubator.

Abstract Background Current criteria for surfactant administration assume that hypoxia is a direct marker of lung-volume de-recruitment. We first introduced an early, non-invasive assessment of lung mechanics by the Forced Oscillation Technique (FOT) and evaluated its role in predicting the need for surfactant therapy. Objectives To evaluate whether lung reactance (Xrs) assessment by FOT within 2 h of birth identifies infants who would need surfactant within 24 h; to eventually determine Xrs performance and a cut-off value for early detection of infants requiring surfactant. Methods We conducted a prospective, observational, non-randomized study in our tertiary NICU in Milan. Eligible infants were born between 27+0 and 34+6 weeks’ gestation, presenting respiratory distress after birth. Exclusion criteria: endotracheal intubation at birth, major malformations participation in other interventional trials, parental consent denied. We assessed Xrs during nasal CPAP at 5 cmH2O at 10 Hz within 2 h of life, recording flow and pressure tracing through a Fabian Ventilator for off-line analysis. Clinicians were blinded to FOT results. Results We enrolled 61 infants, with a median [IQR] gestational age of 31.9 [30.3; 32.9] weeks and birth weight 1490 [1230; 1816] g; 2 infants were excluded from the analysis for set-up malfunctioning. 14/59 infants received surfactant within 24 h. Xrs predicted surfactant need with a cut-off − 33.4 cmH2O*s/L and AUC-ROC = 0.86 (0.76–0.96), with sensitivity 0.85 and specificity 0.83. An Xrs cut-off value of − 23.3 cmH2O*s/L identified infants needing surfactant or respiratory support > 28 days with AUC-ROC = 0.89 (0.81–0.97), sensitivity 0.86 and specificity 0.77. Interestingly, 12 infants with Xrs

This study investigated the relationship between three respiratory support approaches on lung volume recruitment during the first 2 h of postnatal life in preterm lambs. We estimated changes in lung aeration, measuring respiratory resistance and reactance by oscillometry at 5 Hz. We also measured intratracheal pressure in subsets of lambs. The first main finding is that sustained inflation (SI) applied noninvasively (Mask SI; n = 7) or invasively [endotracheal tube (ETT) SI; n = 6] led to similar rapid lung volume recruitment (∼6 min). In contrast, Mask continuous positive airway pressure (CPAP) without SI (n = 6) resuscitation took longer (∼30–45 min) to reach similar lung volume recruitment. The second main finding is that, in the first 15 min of postnatal life, the Mask CPAP without SI group closed their larynx during custom ventilator-driven expiration, leading to intratracheal positive end-expiratory pressure of ∼17 cmH2O (instead of 8 cmH2O provided by the ventilator). In contrast, the Mask SI group used the larynx to limit inspiratory pressure to ∼26 cmH2O (instead of 30 cmH2O provided by the ventilator). These different responses affected tidal volume, being larger in the Mask CPAP without SI group [8.4 mL/kg; 6.7–9.3 interquartile range (IQR)] compared to the Mask SI (5.0 mL/kg; 4.4–5.2 IQR) and ETT SI groups (3.3 mL/kg; 2.6–3.7 IQR). Distinct physiological responses suggest that spontaneous respiratory activity of the larynx of preterm lambs at birth can uncouple pressure applied by the ventilator to that applied to the lung, leading to unpredictable lung pressure and tidal volume delivery independently from the ventilator settings. NEW & NOTEWORTHY: We compared invasive and noninvasive resuscitation on lambs at birth, including or not sustained inflation (SI). Lung volume recruitment was faster in those receiving SI. During noninvasive resuscitation, larynx modulation reduced tracheal pressure from that applied to the mask in lambs receiving SI, while it led to increased auto-positive end-expiratory pressure and very large tidal volumes in lambs not receiving SI. Our results highlight the need for individualizing pressures and monitoring tidal volumes during resuscitation at birth. [ABSTRACT FROM AUTHOR]

Novel therapies are needed for bronchopulmonary dysplasia (BPD) because no effective treatment exists. Mesenchymal stromal cell extracellular vesicles (MSC-sEVs) have therapeutic efficacy in a mouse pup neonatal hyperoxia BPD model. We tested the hypothesis that MSC-sEVs will improve lung functional and structural development in mechanically ventilated preterm lambs. Preterm lambs (∼129 days; equivalent to human lung development at ∼28 wk gestation) were exposed to antenatal steroids, surfactant, caffeine, and supported by mechanical ventilation for 6–7 days. Lambs were randomized to blinded treatment with either MSC-sEVs (human bone marrow MSC-derived; 2 × 1011 particles iv; n = 8; 4 F/4 M) or vehicle control (saline iv; 4 F/4 M) at 6 and 78 h post delivery. Physiological targets were pulse oximetry O2 saturation 90–94% (P⁢aO2 60–90 mmHg), P⁢aC⁢O2 45–60 mmHg (pH 7.25–7.35), and tidal volume 5–7 mL/kg. MSC-sEVs-treated preterm lambs tolerated enteral feedings compared with vehicle control preterm lambs. Differences in weight patterns were statistically significant. Respiratory severity score, oxygenation index, A-a gradient, distal airspace wall thickness, and smooth muscle thickness around terminal bronchioles and pulmonary arterioles were significantly lower for the MSC-sEVs group. S/F ratio, radial alveolar count, secondary septal volume density, alveolar capillary surface density, and protein abundance of VEGF-R2 were significantly higher for the MSC-sEVs group. MSC-sEVs improved respiratory system physiology and alveolar formation in mechanically ventilated preterm lambs. MSC-sEVs may be an effective and safe therapy for appropriate functional and structural development of the lung in preterm infants who require mechanical ventilation and are at risk of developing BPD. NEW & NOTEWORTHY This study focused on potential treatment of preterm infants at risk of developing bronchopulmonary dysplasia (BPD), for which no effective treatment exists. We tested treatment of mechanically ventilated preterm lambs with human mesenchymal stromal cell extracellular vesicles (MSC-sEVs). The results show improved respiratory gas exchange and parenchymal growth of capillaries and epithelium that are necessary for alveolar formation. Our study provides new mechanistic insight into potential efficacy of MSC-sEVs for preterm infants at risk of developing BPD. [ABSTRACT FROM AUTHOR]

High-flow nasal cannula (HFNC) is a non-invasive respiratory support (NRS) modality to treat premature infants with respiratory distress syndrome (RDS). The delivery of nebulized surfactant during NRS would represent a truly non-invasive method of surfactant administration and could reduce NRS failure rates. However, the delivery efficiency of nebulized surfactant during HFNC has not been evaluated in vitro or in animal models of respiratory distress. We, therefore, performed first a benchmark study to compare the surfactant lung dose delivered by commercially available neonatal nasal cannulas (NCs) and HFNC circuits commonly used in neonatal intensive care units. Then, the pulmonary effect of nebulized surfactant delivered via HFNC was investigated in spontaneously breathing rabbits with induced respiratory distress. The benchmark study revealed the surfactant lung dose to be relatively low for both types of NCs tested (Westmed NCs 0.5 ± 0.45%; Fisher & Paykel NCs 1.8 ± 1.9% of a nominal dose of 200 mg/kg of Poractant alfa). The modest lung doses achieved in the benchmark study are compatible with the lack of the effect of nebulized surfactant in vivo (400 mg/kg), where arterial oxygenation and lung mechanics did not improve and were significantly worse than the intratracheal instillation of surfactant. The results from the present study indicate a relatively low lung surfactant dose and negligible effect on pulmonary function in terms of arterial oxygenation and lung mechanics. This negligible effect can, for the greater part, be explained by the high impaction of aerosol particles in the ventilation circuit and upper airways due to the high air flows used during HFNC.

Engaging with research on protest participation and gender inequalities, we examine how gender dynamics play a crucial role in shaping patterns of protest participation across the rural/urban divide. We argue that moving from a rural toward an urban setting leads to an increase in protest participation for women, but not for men. Using an original two-wave panel survey dataset collected for the same individuals between 2018 and 2019 and covering nine European countries, we are able to go beyond traditional correlation analyses and measure our key variables over time, thus developing a dynamic approach that links differences in gender, socio-geographical positioning and protest participation. Our findings demonstrate that the rural/urban divide as a driver of protest participation affects women and men differently, because it might be shaped by different experiences of political socialization, socio-economic status and structures of domination and discrimination, leading to different opportunities and incentives for mobilization. [ABSTRACT FROM AUTHOR]

While there is extensive literature about public concern about climate change, most studies rely on cross-sectional static data. Based on a unique panel survey conducted in nine European countries in 2018 and 2019, we make a rare investigation of factors that explain why some young people (age: 18–34 years) are, have become or have lost their concern about climate and environmental issues at times of widespread discussions about the climate emergency. The analysis tests argument about the importance of individual-level factors such as values and political orientations and consider the role of cross-national variations, the experience of extreme weather events and youth-led climate strikes. Our results support prior studies as we find that young people with libertarian rather than authoritarian values, with more positive views towards immigration and redistribution policies, tend to be more concerned about climate change and the environment. We find little effect of contextual factors. Young people who have experienced economic hardship and have a right-wing political orientation are less likely to become concerned for climate and environmental issues. Socio-economic conditions, values and political orientations are crucial to understanding climate concern among young Europeans, affecting youth climate engagement at times of increasing inequalities and polarization. [ABSTRACT FROM AUTHOR]

Contemporary anti-gender movements mobilize against gender and sexual equality for which feminist and LGBTQI+ movements have been advocating for decades. We propose the term 'contentious gender politics' to capture this clash of opposing movements concerning bodily integrity, kinship structures, sexual morality, and institutionalization of gender equality. Existing literature has recognized the transnational character of anti-gender movements and identified matching tactics, frames, and allies across different countries. We examine how these transnational movements used similar campaigns to 'localize'. Localization is conceptualized in this research as the process of adapting frames and tactics to different national contexts. To do so, this study examines the diffusion of social movements and anti-gender campaigns by comparing anti-gender movements in Italy and Croatia through critical events between 2013 and 2019. We demonstrate that the localization of these anti-gender movements occurred through a three-step pathway: first, by adapting frames and tactics of left-liberal civil society and progressive movements; second, by forging alliances with existing right-wing parties; and third, by embedding its agenda within formal political and administrative bodies. [ABSTRACT FROM AUTHOR]

Introduction: We evaluate the accuracy of postnatal biochemical and lung function tests performed within 3 h from birth for predicting surfactant need in preterm infants ≤34 weeks' gestation receiving noninvasive respiratory support for respiratory distress syndrome (RDS). Methods: We systematically searched MEDLINE, Embase, The Cochrane Library, PROSPERO, and clinicaltrials.gov databases for studies published from 2000 to November 10, 2021, cross-referencing relevant literature and contacting experts. We included diagnostic accuracy studies and systematic reviews of biochemical or lung function tests identifying the need for surfactant in preterm neonates ≤34 weeks' with RDS not intubated at birth. The authors individually assessed the risk of bias following a tailored QUADAS-2 tool. Results: Eight studies, including 810 infants, met the inclusion criteria. Four tests were included: the click test, the stable microbubble test, the lamellar body count on gastric aspirates, and the forced oscillation technique. The reference standards were transparent criteria for distinguishing the infants according to oxygen requirement, which reflected the current criteria for surfactant therapy. The risk of bias was judged high because of the population selection and exclusion of participants from the analysis. There were no serious concerns regarding blinding and applicability. The individual study sensitivity and specificity range from 0.60 to 1 and from 0.51 to 0.91, respectively. It was not appropriate to combine the accuracy estimates in a meta-analysis because of the heterogeneity of the study characteristics. Conclusions: Current evidence is insufficient to recommend biochemical and lung function tests for tailoring surfactant therapy. [ABSTRACT FROM AUTHOR]

Following the death of George Floyd on May 25, 2020 and inspired by the actions of the Black Lives Matter movement in the United States, in June 2020 a wave of protest events spread across Europe as well. Based on in‐depth interviews with key informants involved in the BLM campaign and a systematic mapping of protest events, the article analyses the diffusion of the Black Lives Matter movement campaign in Italy. We investigate the conditions for the diffusion, by considering the resonance of the protests in a time of backlash and pandemic; the channels of diffusion, namely mechanisms of thin diffusion linked to the instantaneous exchange of protest content; and the effects of diffusion, in terms of recontextualization of ideas and narratives from the United States to the Italian context, the emergence of new antiracist organizations and intersectional frames that point at Italian colonialism and structural racism. [ABSTRACT FROM AUTHOR]

Several experimental studies are conducted to explain the impact of the electrical properties and structural relaxation (SR) of the chalcogenide materials on the phase-change memory (PCM) cells. A high current or high voltage readout is shown to highly improve the resistance stability of the system.

The article presents and examines a new physical model, which is employed to demonstrate the impact of structural relaxation (SR) of the chalcogenide materials on the reliability of phase-change memory (PCM) cells. The defect annihilation dynamics is also shown to be highly affected by the electrical characteristics of the cells.