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Background: Erectile dysfunction (ED) is a multifaceted yet prevalent male-related sexual dysfunction that manifests as a change in any of the erectile response components, including relational, psychological, and biological. We aimed to use bibliometric analyses to determine how ED research has progressed and define the future trends necessary to contribute to scholarly literature.Methods: Two tools, VOSviewer and MS Excel, were used, and the study was conducted in May 2022. A total of 16,114 records were selected for in-depth analyses. We examined the most eminent authors, highly cited papers within journals, and the institutions that have provided the greatest number of articles regarding ED, and demonstrated that ED research has increased over the last two decades.Results: The total number of research documents published between 1971 and 2021 was 16,114, with a growth rate of 5%. Montorsi, Maggi, and Mulhall shared the top spot in the number of publications (n = 164). The Journal of Sexual Medicine has the most papers (N = 1839), followed by the International Journal of Impotence Research (N = 780), the Journal of Urology (N = 557), and Urology (N = 489).Conclusion: The study revealed increased ED research in the past two decades, with notable authors and sources identified. The top three countries contributing to ED are the UK, Italy, and the USA. Recommendations include interdisciplinary collaboration, novel therapeutic approaches, addressing psychological and relational factors, conducting longitudinal studies, and publishing in reputable journals. Implementing these can advance understanding, improve treatment options, and enhance ED management. [ABSTRACT FROM AUTHOR]

Understanding lay theories on the causes of economic inequality is the first step to comprehending why people tolerate, justify, or react against it. Accordingly, this paper aims to develop and validate with two cross-sectional studies the Attributions for Cross-Country Inequality Scale (ACIS), which assesses how people explain cross-country economic inequality–namely, the uneven distribution of income and wealth between poor and rich countries. After selecting and adapting items from existing scales of attributions for poverty and wealth, in Study 1, we tested the factorial structure of this initial pool of items in three countries with different levels of economic development and inequality, namely, Italy (n = 246), the UK (n = 248), and South Africa (n = 228). Three causal dimensions emerged from the Exploratory Factor Analysis: "rich countries" (blaming the systematic advantage of and exploitation by rich countries), "poor countries" (blaming the dispositional inadequacy and faults of poor countries), and "fate" (blaming destiny and luck). The retained items were administered in Study 2 to three new samples from Italy (n = 239), the UK (n = 249), and South Africa (n = 248). Confirmatory Factor Analysis (CFA) corroborated the factorial structure of the ACIS, and Multi-Group CFA supported configural and metric invariances of the scale across countries. In addition, we show internal consistency and construct validity of the scale: the scale correlates with relevant constructs (e.g., beliefs about cross-country inequality and ideological orientation) and attitudes toward relevant policies related to international redistribution and migration. Overall, the scale is a valid instrument to assess causal attribution for cross-national inequality and is reliable across countries. By focusing on resource distribution from an international perspective, this scale will allow researchers to broaden the discussion on economic inequality to a global level. [ABSTRACT FROM AUTHOR]

As humanity reaches the 5.0 industrial revolution, education plays a critical role in boosting the quality of human resources. This paper reports bibliometric research on emerging TiP during 1993-2022 in the educational field to analyse its development on any level of education during the last three decades. This study employed a Scopus database. The findings are that the trend of TiP publication in educational fields has tended to increase every year during the past three decades and conference paper became the most published document type, the USA is the country which produces the most publications; "Students" being the most occurrences keyword and total link strength. The publication of the TiP is ranked to the Quartile 1, which implies that a publication with the cited performance is a publication with credibility because the publisher has a good reputation. Researchers can find the topics most relevant to other metadata sources such as Web of Science, Publish, and Perish.

Acknowledging the extreme risk COVID-19 poses to humans, this paper attempted to analyze and compare case fatality rates, identify the existence of learning curves for COVID-19 medical treatments, and examine the impact of vaccination on fatality rate reduction. Confirmed cases and deaths were extracted from the "Daily Situation Report" provided by the World Health Organization. The results showed that low registration and low viral test rates resulted in low fatality rates, and the learning curve was significant for all countries except China. Treatment for COVID-19 can be improved through repeated experience. Vaccinations in the U.K. and U.S.A. are highly effective in reducing fatality rates, but not in other countries. The positive impact of vaccines may be attributed to higher vaccination rates. In addition to China, this study identified the existence of learning curves for the medical treatment of COVID-19 that can explain the effect of vaccination rates on fatalities. [ABSTRACT FROM AUTHOR]

The paper aims to understand if and which lessons have been learned since the financial crisis of 2007-2008, highlighting the main deficiencies which still affect the corporate governance and risk management systems more than a decade after. A survey was performed by collecting the answers to 15 questions about corporate governance and risk management practices, given by a representative sample of 200 finance professionals (100 from the USA, 50 from Italy, 50 from the UK). The survey allows saying that corporate governance codes and risk management approach, even though improved and implemented over the past decade, still present problems in terms of principles or application. The results provide insights into how corporate governance issues are addressed and how financial institutions and regulators learn and adapt from a crisis. The paper also gives new perspectives on corporate governance, indicating where regulators need to focus on to rethink the governance mechanisms. [ABSTRACT FROM AUTHOR]

Housing policies are a complex set of taxes, benefits and incentives. This paper evaluates the redistributive effect of a comprehensive set of housing-related policies, taking into account the housing advantage of homeowners and social tenants. We use the Euromod microsimulation model to simulate housing policies in Estonia, Italy and the United Kingdom. Disentangling the contribution to inequality and poverty of each housing-related policy, we find that the current design of property taxes is not progressive and that other housing policies have a limited impact on inequality in Estonia and on both inequality and relative poverty in Italy. Only in the UK are housing policies more important than imputed rent in reducing inequality and poverty. In all three countries, housing-related policies favor the elderly. Although the United Kingdom has the most effective system of housing policies, Estonia seems to have the most efficient one. [ABSTRACT FROM AUTHOR]

Background The dissemination of scientific data on coronavirus disease 2019 (COVID-19) continually builds but, in April 2020, could not keep up with the spread of the disease. Through technology, surgeons in Italy and the UK, representing both peak and pre-peak infective time zones, were able to communicate so that the urgent lessons on the huge expected demands of care learned in Italy could be brought to the UK in advance. This paper specifically discusses the issues related to paediatric surgery, currently under-reported in the literature. Methods The aim of this paper is to conjoin experience from the field to provide a framework for a safe assessment and treatment of paediatric patients by adopting a systemic approach aimed at reducing the risk of contamination. We reviewed the processes and good practices that were undertaken in contexts of emergency such as in Italy and the UK and then adapted them within the Systems Engineering Initiative for Patient Safety (SEIPS) framework to provide an assessment of how to reorganize the services in order to cope with an unexpected situation. The SEIPS model is the adopted theoretical framework, which allows to analyse the system in its main components with a human factors and ergonomics (HFE) perspective. Results The results introduce some of the good practices and recommendations developed during the emergency in the surgical scenario with a focus on the paediatric patients. They represent the lessons learned from the combination of the little existing evidence of literature and the experience from surgical teams who responded in an impromptu and unrehearsed way. Conclusions Lessons learned from the frontline 'on the fly' during COVID-19 emergency should be consolidated and taken into the future. In order to prepare proactively for the next phases and get ahead of the curve of these hospital accesses, there is a need for a risk assessment of the new clinical pathways with a multidisciplinary approach centred on HFE with the adoption of the SEIPS model and an involvement of all the surgical teams. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has been characterized by a social media "infodemic": an overabundance of information whose authenticity may not always be guaranteed. With the potential to lead individuals to harmful decisions for the society, this infodemic represents a severe threat to information security, public health and democracy. In this paper, we assess the interplay between the infodemic and specific aspects of the pandemic, such as the number of cases, the strictness of containment measures, and the news media coverage. We perform a comparative study on three countries that employed different managements of the COVID-19 pandemic in 2020—namely Italy, the United Kingdom, and New Zealand. We first analyze the three countries from an epidemiological perspective to characterize the impact of the pandemic and the strictness of the restrictions adopted. Then, we collect a total of 6 million posts from Facebook to describe user news consumption behaviors with respect to the reliability of such posts. Finally, we quantify the relationship between the number of posts published in each of the three countries and the number of confirmed cases, the strictness of the restrictions adopted, and the online news media coverage about the pandemic. Our results show that posts referring to reliable sources are consistently predominant in the news circulation, and that users engage more with reliable posts rather than with posts referring to questionable sources. Furthermore, our modelling results suggest that factors related to the epidemiological and informational ecosystems can serve as proxies to assess the evolution of the infodemic. [ABSTRACT FROM AUTHOR]

This paper presents some possibilities for applying the linguistic and psychological theories of two dialogists, Mikhail Bakhtin and Jacques Lacan, to the classroom. There is a short summary of how the two theories may interact with each other and then a discussion of their two opposing views of identity formation. Bakhtin was a Russian, coming from the collectivist paradigm and Lacan's theories were arcane combinations of Freud's emphasis on the needs of the individual and French post-Revolutionary individualism. Lacan insisted that one could only become "whole" at the cost of incompleteness for another. Bakhtin opined that completeness could only be achieved within experiences shared and co-constructed by others. This paper concludes with the question of how teachers can ensure the positive experience of co-construction rather than one person paying a cost for the other's identity-formation and whether it is possible to fully implement insights from a collectivistic paradigm in an education system where the stated aim is to enable each individual to meet his/her potential. (Contains 1 figure and 1 footnote.)

The higher education efficiency evaluation model using the data envelopment analysis method has interested many researchers. This paper uses bibliometric analysis on publications extracted from the Scopus database to provide a comprehensive overview of research publications on the measurement of higher education efficiency based on data envelopment analysis: its growth rate, major collaboration networks, the most important and popular research topic. A total of 169 related publications were collected and analyzed from 1988 to 2021. The analysis results show that: Publications published every year have increased sharply in the last six years; The quality of publications is relatively high as publications tend to be published in journals with high-ranking indexes; Countries with the most influence in studies on this topic are: Italy, China, Spain, the USA, and the United Kingdom; Authors with the most influence in this research direction are Agasisti T., Abbott M., Doucouliagos C., Avkiran N.K., and Johnes J.; The research cooperation among countries and among affiliations is not strong. Finally, the paper has provided recommendations for future studies based on the findings.

Notable cross-country differences exist in the diffusion of the Covid-19 and in its lethality. Contact patterns in populations, and in particular intergenerational contacts, have been argued to be responsible for the most vulnerable, the elderly, getting infected more often and thus driving up mortality in some context, like in the southern European one. This paper asks a simple question: is it between whom contacts occur that matters or is it simply how many contacts people have? Due to the high number of confounding factors, it is extremely difficult to empirically assess the impact of single network features separately. This is why we rely on a simulation exercise in which we counterfactually manipulate single aspects of countries' age distribution and network structures. We disentangle the contributions of the kind and of the number of contacts while holding constant the age structure. More precisely, we isolate the respective effects of inter-age contact patterns, degree distribution and clustering on the virus propagation across age groups. We use survey data on face-to-face contacts for Great Britain, Italy, and Germany, to reconstruct networks that mirror empirical contact patterns in these three countries. It turns out that the number of social contacts (degree distribution) largely accounts for the higher infection rates of the elderly in the Italian context, while differences in inter-age contacts patterns are only responsible for minor differences. This suggests that policies specifically targeting inter-age contacts would be little effective. [ABSTRACT FROM AUTHOR]

Interest in higher education institutions (HEIs) as instruments for development has increased in recent years. The main objective of this paper is to address the contribution of HEIs to development through their missions, models, and challenges. With this purpose, we perform a historical analysis and characterise higher-education systems through the perspective of university models and missions, noticing relevant aspects regarding the evolution of this institution over time, as well as the transformations undergone. We also consider the main challenges that current higher education systems face in the 21st century. As methodological approaches, we carry out a literature review complemented by a comparative analysis based on data from the higher education systems of ten European countries. The findings show that HEIs can contribute to development through their missions, which are related to the models of higher education. Their first mission (teaching) contributes to improving human capital and attracting highly qualified people to their regions; the second mission (research) improves scientific knowledge which can foster innovative activities; and the third mission (community service) acts as a link between research and business, including patents, business incubators, and collaboration agreements. We also conclude that the challenges of higher education in the 21st century can be categorised essentially in three main areas: (1) globalisation and massification of higher education, as well as the internationalisation of HEIs' missions and diversification of the educational supply to attract new students; (2) new technologies related to the digitalisation of teaching and distance learning; and (3) higher education entrepreneurship, showing the importance of university-company relationships. This paper provides a global setting for a reflection on the role of HEIs in the 21st century, given their connection with society and the need for a more effective contribution to socio-economic development.

The need for self-directed learning for professional development drives an increase in the delivery of easy to use 'just-in-time' resources that respond to the often-dynamic workplace and work culture. This is especially important in the era of globalisation, when the number of employees, who are culturally diverse, increases each year. Most medium and large companies operate in an international environment, and this is due to the expansion of international enterprises with branches in various countries that requires cooperation with foreign clients, and the employment of foreign nationals in their companies. In order to guarantee the effectiveness of workings in companies, there is a need for continuous education in the aspect of the cultural diversity. This paper explores micro-learning, which focuses on delivering brevity through bite-sized learning units or short-term learning activities. Learning content in this case can take many forms, from text to interactive multimedia. These contents are often created on demand, which can sometimes be less contextualised and pedagogically informed. Based on a case study of the need for training on cultural risks in multi-cultural organisations, this paper focuses on the design of mini-games as playful learning resources for supporting an online learning platform that has been developed as a response to this training need. Fifteen mini-games have been developed to complement eight main topics related to cultural risks and to promote reflection, practice and the self-assessment of knowledge acquired through the platform. The main eight topics represent the risk areas identified that include cultural awareness, understanding different cultures, communication, learning styles, hierarchy, team-working, qualities in the working place, and stereotypes through a survey carried out with personnel (n=154) from multi-cultural organisations across five countries - Cyprus, Italy, Latvia, Poland, and the UK. The discussions include unpacking the mapping of pedagogical and gameful design considerations based on Arnab et al.'s (2015) Learning Mechanics-Game Mechanics Mapping (LMGM) model. The paper also discusses the findings from the testing of the online platform across 5 countries including 166 participants (two-step testing). The insights provided will be valuable to researchers, practitioners, designers, and developers of micro-learning resources.

This rapid systematic review aims to examine emerging evidence on the effects of COVID-19 on educational institutions and assess the prevalence of e-learning changes in the sector. This paper reviews literature on learning, teaching, and assessment approaches adopted since the COVID-19 outbreak, and assesses the impact on the sector, staff, and students, summarizing findings from peer-reviewed articles. It categorizes these into five key themes: (1) digital learning; (2) e-learning challenges; (3) digital transition to emergency virtual assessment (EVA); (4) psychological impact of COVID-19; and (5) creating collaborative cultures. This represents the first systematic review of COVID-19's impact on education, clarifying current themes being investigated. The author suggests that the term 'emergency virtual assessment' (EVA) is now added for future research discussion. Finally, the paper identifies research gaps, including researching the impact on lesser developed countries, the psychological impact of transition, and the important role of leadership and leadership styles during the transition and handling of the pandemic.

BACKGROUND Family patterns in Western countries have changed substantially across birth cohorts. The spread of unmarried cohabitation, the decline and postponement of marriage and fertility, and the rise in nonmarital births, partnership instability, and repartnering lead to an increasing diversity in family life courses. OBJECTIVE In this paper we demonstrate how to set up a tool to explore family life trajectories. This tool models the changing family patterns, taking into account the complex interrelationships between childbearing and partnership processes. METHODS We build a microsimulation model parameterised using retrospective partnership and childbearing data. The data cover women born since 1940 in Italy, Great Britain, and two Scandinavian countries (Norway and Sweden), three significantly different cultural and institutional contexts of partnering and childbearing in Europe. RESULTS We guide readers through the modelling of individual life events to obtain a set of aggregate estimates, providing information on the power, technical structure, and underlying assumptions of microsimulations. Validation of the simulated family life courses against their real-world equivalents shows that the simulations not only closely replicate observed childbearing and partnership processes, but also provide high quality predictions when compared to more recent fertility indicators. CONCLUSIONS Using observed population estimates to systematically validate the results both validates our model and increases confidence that microsimulations satisfactorily replicate the behaviour of the original population. [ABSTRACT FROM AUTHOR]

This paper discusses why there is a need for a more profound analysis of the European SMEs in the context of knowledge transfer within the state of generational change of the managing board. This paper forms basis for a doctoral thesis on this topic. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to investigate the use of innovative workplace practices in a sample of manufacturing establishments. Design/methodology/approach -- The sample comprises manufacturing establishments located in Italy and a comparable sample extracted from the British Workplace Employee Relations Survey (WERS). The paper controls for sector, size, skill quality and industrial relations. Findings -- Job rotation and technical training are positively associated with current performance in both samples. On average, British establishments are more productive: the different endowment in terms of workplace practices, skills and industrial relations accounts for 40 per cent of the gap, while the different efficacy of the endowment on performance accounts for the remainder. Originality/value -- In both samples the introduction of team working implies a relatively important advance along the reorganisation process, which was undertaken in the early stages of reorganisation in British establishments but much later in Italian firms. Linking the progression of the reorganisation to non-convexities in supermodular production functions may be an interesting line of future research. [ABSTRACT FROM AUTHOR]

Background: The quality of biomedical reporting is guided by statements of several organizations. Although not all journals adhere to these guidelines, those that do demonstrate ''editorial leadership'' in their author community. To investigate a possible relationship between editorial leadership and journal quality, research journals from two European countries, one Anglophone and one non-Anglophone, were studied and compared. Quality was measured on a panel of bibliometric parameters while editorial leadership was evaluated from journals' instructions to authors. Methodology/Principal Findings: The study considered all 76 Italian journals indexed in Medline and 76 randomly chosen UK journals; only journals both edited and published in these countries were studied. Compared to UK journals, Italian journals published fewer papers (median, 60 vs. 93; p = 0.006), less often had online archives (43 vs. 74; p<0.001) and had lower median values of impact factor (1.2 vs. 2.7, p<0.001) and SCImago journal rank (0.09 vs. 0.25, p<0.001). Regarding editorial leadership, Italian journals less frequently required manuscripts to specify competing interests (p<0.001), authors' contributions (p = 0.005), funding (p<0.001), informed consent (p,0.001), ethics committee review (p<0.001). No Italian journal adhered to COPE or the CONSORT and QUOROM statements nor required clinical trial registration, while these characteristics were observed in 15%-43% of UK journals (p<0.001). At multiple regression, editorial leadership predicted 37.1%-49.9% of the variance in journal quality defined by citation statistics (p<0.0001); confounding variables inherent to a cross-cultural comparison had a relatively small contribution, explaining an additional 6.2%-13.8% of the variance. Conclusions/Significance: Journals from Italy scored worse for quality and editorial leadership than did their UK counterparts. Editorial leadership predicted quality for the entire set of journals. Greater appreciation of international initiatives to improve biomedical reporting may help low-quality journals achieve higher status. [ABSTRACT FROM AUTHOR]

This paper describes a study of doctors and the education of doctors in Germany, Italy and the UK and the changing location of accounting practices and expertise. In these countries there have been coercive reform attempts to get doctors to accept increased financial responsibility and pay greater attention to costs and budgets.suggested that Finnish doctors have willingly adopted accounting practices as part of their legitimated competencies and have become a hybrid profession. This paper address the question of whether that is a valid generalisation in Germany, Italy or the UK. The key focus of the paper is on the education and training of doctors, which should have altered if hybridisation has occurred. The finding is that there is no evidence from the countries studied that accounting has become incorporated into the formal education of doctors. While there were management and accounting training courses for doctors these were only available for those in or aiming for clinico-managerial positions. This does not support the argument that medicine has become a hybridised profession, but it does support the case for polarisation. These changes are absorbed or managed by an emergent sub-group, the medical manager. [ABSTRACT FROM AUTHOR]

Background: Frailty is a clinical state that increases susceptibility to minor stressor events. The risk of frailty is higher in chronic conditions, such as Chronic Obstructive Pulmonary Disease (COPD). Recent studies on COPD have shown that patients living with frailty have an increased risk of mortality. The presence of cardiovascular diseases or conditions are common in COPD and may increase the risk of death. Methods: This protocol describes a European prospective cohort study of community-based people, in a stable condition with diagnosis of COPD (as defined by GOLD guidelines) across hospitals in Italy and UK. Frailty prevalence will be assessed using the Clinical Frailty Scale. At 1- and 2-year follow up, primary outcome will be the impact of frailty on the number of cardiovascular events; secondary outcomes: the influence of frailty on cardiovascular mortality, all-cause mortality, and deaths due to COPD. For the primary outcome a zero-inflated Poisson regression will compare the number of cardiovascular events at 1 year. Secondary outcomes will be analysed using the time to mortality. Discussion: This multicentre study will assess the association between frailty and cardiovascular events and mortality in population with COPD. Data collection is prospective and includes routine clinical data. This research will have important implications for the management of patients with COPD to improve their quality of care, and potentially prognosis. Trial registration number: NCT05922202 (www.clinicaltrials.gov). [ABSTRACT FROM AUTHOR]

A MIMO GB-SAR system called MELISSA was put in place to monitor landslides in Italy and the sinking of the Costa Concordia cruise liner in France. It comprises 12 pyramidal horn antennas placed in a linear geometry for transmission, and these are used in the detection of the motion of a target (for example a landslide or other terrestrial deformation). The low half power beam width (19.76° at θ = 90°) of the transmitting radiation pattern of MELISSA results in low coverage area of the target. This paper proposes two alternative types of horn antenna for the current transmitter module of MELISSA, namely the cantenna and coaxial cavity horn antenna, for installation in a 2×6 planar antenna array. A higher value of the 3 dB beamwidth is observed using these arrays (38.320 at θ = 90° and 104.80 at φ = 0° for the cantenna array and 410 at θ = 90° and 140.40 at φ = 0° for the coaxial cavity horn antenna array). The overall gain of the proposed systems is around 10 dBi, and the efficiencies are between 85% and 90%. Using the Dolph Chebyshev beamforming technique on the proposed antenna arrays yields a zero sidelobe level, which improves the overall peak sidelobe ratio of the system and in turn the quality of the images obtained. Our proposed design for the transmitting section of the MELISSA system has applications terrestrial deformation monitoring with higher area coverage. [ABSTRACT FROM AUTHOR]

Introduction Background and rationale Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis is considered the procedure of choice in patients with ulcerative colitis (UC) refractory to medical therapy and in those who develop colonic dysplasia or cancer. 1 The procedure is performed with the aim of improving quality of life with generally good outcomes; 2 , 3 however, complications including pouchitis can arise. The incidence of acute pouchitis is 20% at 1 year and up to 40% at 5 years following surgery. 4 Chronic idiopathic pouchitis develops in ~10%–15% of patients with acute pouchitis. 5 , 6 Another less well-reported complication is prepouch ileitis (PPI). PPI has no standard definition but is inflammation of the ileum proximal to the pouch. The estimated frequency of PPI is 6%. 7 , 8 This pattern of inflammation can extend for a significant distance into the afferent limb (up to 50 cm), 9 but this is unusual. 8 It is usually seen with coexisting pouchitis. It is mostly a condition that is associated with a pouch for UC and is rarely seen in patients who have undergone a pouch for familial adenomatous polyposis. 9 This therefore suggests that both the immune system and the environment interact within a genetically susceptible patient to cause inflammation. As the immune system is likely to play a role in PPI, the use of biologic medications may potentially help achieve remission through the immunomodulatory actions. Furthermore, biologic drugs have been shown to result in remission in about 50% of patients with inflammation of their pouch. 10 As it has been shown that PPI is often associated with pouchitis, it may therefore be beneficial in treating this problem. 8 , 11 Symptoms of PPI are generally nonspecific but can include increased stool frequency, outlet obstruction, and bleeding. 12 The treatment of PPI as a specific entity has been poorly studied, but it is generally treated concurrently with pouchitis. One small study looked at the effects of antibiotics on PPI in a cohort with a diagnosis of UC and showed that 86% of patients showed symptomatic improvement with significant reduction in both stool frequency and length of PPI. However, this was based on only 14 patients. Furthermore, there has been only one small case series of five patients where infliximab was found to be effective in the short term for the specific treatment of PPI in a cohort with a diagnosis of Crohn's disease. 13 Historically, the limited literature reporting outcomes of biologic therapy for PPI has assumed that PPI is a Crohn's-like complication. 13 – 15 Recent studies, however, have highlighted that PPI is not a strong predictor for the development of unequivocal features of Crohn's disease, 11 , 12 and therefore, it is important to report treatment outcomes dependent on whether Crohn's disease is thought to be the underlying cause or not. Objectives This aim of this study was to document the efficacy of biologics for the treatment of PPI. To our knowledge, this is the largest study to explore the efficacy of all biologics for the specific treatment of PPI with the longest follow-up data. Methods Study design and setting This was a retrospective observational study across three centers. Data were collected from two centers in the UK and one center in Bologna, Italy. This included two tertiary referral centers and one district general hospital. Patients were censored at the last clinical encounter following their most recent biologic therapy or until they had pouch failure defined by the need to form an ileostomy to relieve symptoms. Participants Patients were included if they met all of the following inclusion criteria: Undergone restorative proctocolectomy for UC Evidence of PPI on endoscopic assessment with inflammation confirmed histologically Treated with infliximab, adalimumab, or vedolizumab (other biologics were not available at our centers during the study period) Variables Patients were followed up until last clinical encounter. Outcomes included the presence of PPI following biologic therapy, pouch failure defined by the need for an ileostomy, remission of PPI defined by the absence of any prepouch inflammation on endoscopic assessment within a year of biologic therapy and the need to switch to an alternative biologic. Primary nonresponse was defined as failure of clinical improvement at 12 weeks of biologic therapy. Secondary loss of response was defined as lack of clinical response to biologic therapy after 12 weeks of treatment. Lack of clinical benefit was judged by the senior clinician looking after the patient and was guided by symptoms, endoscopic, histological, and biochemical markers. A template data collection sheet was given to each sub-investigator to collect the variables of interest. Potential patients were identified using each hospital's biologics and pouch databases. Those patients identified from the database were then screened against the inclusion and exclusion criteria by interrogation of the patient's electronic and case notes. Completed templates were then collated and analyzed. Measurement of variables The use of the term Crohn's disease (CD) is controversial in pouch-related inflammatory problems. 16 In our study, we defined this by the presence of conclusive histology (granulomas supporting CD) and/or presence of skip lesions in the small bowel. Pouchitis was defined using the pouch disease activity index (PDAI). 17 Patients were classified as having pouchitis if their PDAI within 1 year before starting infliximab was ≥7. PPI was defined as any inflammation immediately proximal to the pouch; inflammation was defined if the endoscopist reported the presence of edema, ulceration, erythema, or contact bleeding in the immediate prepouch ileum with histological confirmation of inflammation in that section. Statistical methods All variables were analyzed using STATA (StataCorp LP, College Station, TX, USA). Ethical approval Ethical approval was granted by the Health Research Authority (IRAS ID: 233311). The study was considered a service evaluation study, and hence as anonymized data were used, written consent was not required by our ethics committee. Local ethics was not considered a requirement by Malpighi Hospital as the study was considered an audit of practice. The study was carried out in accordance with the principles of the declaration of Helsinki. Results There were 29 patients in our cohort. The median age of diagnosis of UC was 27 years (range 6–48 years). The median age of the patients at censorship was 53 years (range 19–68 years). The median time from pouch formation to diagnosis of PPI was 79 months (range 1–147 months). The median length of time a patient was on biologics at censorship was 12 months (range 2–62 months). The median length of follow-up on the whole cohort was 21 months (range 1–99 months) (Table 1). Table 1 Baseline characteristics Abbreviations: CD, Crohn's disease; IBD, inflammatory bowel disease; PPI, prepouch ileitis; UC, ulcerative colitis. Ten patients were reclassified as having confirmed CD after a median time from formation of pouch of 202 months (range 1–372 months; Figure 1). Six had granulomas on further histological assessment and skip lesions on small bowel imaging and four had granulomas on histology alone. Figure 1 Kaplan–Meier graph for pouch failure. Notes: Log rank test comparing "survival" times in the two groups P=0.72, no evidence of a difference between groups. Abbreviations: CD, Crohn's disease; UC, ulcerative colitis. Change of medications One patient had primary nonresponse to infliximab and was changed to vedolizumab. Nine other patients had secondary loss of response to infliximab; of these, six were changed to adalimumab and three were changed to vedolizumab. Of all those in whom the first biologic failed, the median time to failure was 12.0 months (range 2–39 months). Remission and pouch failure At last endoscopic follow-up within 1 year of starting a biologic, 20 of 29 patients still had endoscopic evidence of PPI, seven had achieved remission, and two had no endoscopic follow-up. Of the six patients who achieved endoscopic remission, four had a biopsy from the prepouch ileum which demonstrated histological remission. The other two were not biopsied at endoscopic follow-up. Of the seven who had achieved remission, five have stopped all medications and remained clinically well, one was taking colifoam enemas and one used cyclical metronidazole to maintain symptomatic response. All patients who had achieved remission were patients who had their biologic for PPI with coexisting pouchitis. In our cohort, 11 patients went on to pouch failure after a median time from starting a biologic of 25 months (range 14–91 months). Of those who had their UC reclassified to CD, three of ten patients (30%) had pouch failure compared with eight of 19 (42%) who had UC (P=0.72) (Figure 1). The cumulative 1-, 2-, 5-, and 8-year failure rates were 0%, 17%, 30%, and 38%, respectively (Figure 1). Discussion PPI remains a difficult condition to treat. Our study has highlighted that the use of biologics for PPI is associated with relatively low remission rates of 31% at a median follow-up of 20.5 months (range 1–99 months). When using biologics for PPI, there was pouch failure in just over one third of the cohort after a median follow-up of 25 months (range 14–91 months). In our small cohort, we found that PPI associated with CD had lower rates of failure than PPI with UC but this was not statistically significant. Although it is hard to draw conclusions in a small study, it is possible that PPI associated with CD has different response rates to PPI associated with UC but this will require further exploration in larger prospective studies. There are a paucity of data highlighting the outcomes of biologic treatments in inflammatory pouch problems. A systematic review that included all chronic inflammatory pouch problems highlighted that remission could be achieved in 53%. 18 Only under a quarter of patients achieved remission from their PPI when using a biologic, suggesting that the presence of PPI is associated with a less favorable treatment response. It has been shown that PPI is often associated with pouchitis. 8 , 11 As such it is difficult to know what additional contribution to symptoms is made by PPI, or if PPI in isolation requires any different treatment from pouchitis, or indeed should be classified as CD, as it effectively represents a skip lesion. It has however been demonstrated that PPI is likely to be a poor prognostic sign and associated with higher rates of pouch failure 19 and therefore treatment with the aim of achieving remission may be associated with better outcomes. This study has highlighted that PPI has practical and clinical implications. It is therefore essential that this complication is recorded during endoscopic pouch assessment. This study is limited by small numbers and retrospective analysis. It is also limited by relative heterogeneity in patient cohort. Ideally future studies should explore comparing treatments for PPI in direct head to head trials. It is also surprising that no patients had prior exposure to a biologic. It has been reported that in patients with UC who require a biologic, those previously exposed to a biologic had poorer outcomes than those who had never previously been exposed to a biologic medication 20 and so future work may help understand if this trend also occurs in those with PPI. A standard definition of PPI would also aid our understanding and outcomes of this complication, which has been shown to have a poorer prognosis than pouchitis in isolation. Conclusion To our knowledge, this is the largest study to explore the efficacy of all biologics for the specific treatment of PPI with the longest follow-up data. Biologics fail to achieve endoscopic remission of PPI in the majority of patients. In a small proportion of patients, they may help to prevent deterioration in pouch dysfunctional symptoms. In a large proportion of patients with PPI, surgery with indefinite diversion may be required despite biologic use. Acknowledgments This paper was presented in abstract form at the British Society of Gastroenterology Conference in Liverpool, UK, 2018 with interim findings. The poster's abstract was entitled "Biological therapy for the treatment of pre-pouch ileitis: a retrospective experience from three centres" and was published in "Poster Abstracts" GUT which can be found at: http://dx.doi.org/10.1136/gutjnl-2018-BSGAbstracts.183 (category: inflammatory bowel disease). Author contributions JPS, MR, CV, and RKF collected the data. JPS analyzed the data and prepared the manuscript. JPS and PB performed statistical analysis. JPS, MR, CV, RKF, GHTW, SDM, ALH, SKC, and ODF have revised the manuscript critically and prepared the final version of the manuscript. All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work. Disclosure The authors report no conflicts of interest in this work. References 1. Sandborn WJ. Pouchitis: definition, risk factors, frequency, natural history, classification, and public health perspective. Trends Inflamm Bowel Dis Ther 1996. 1997. 2. de Buck van Overstraeten A, Wolthuis AM, Vermeire S, et al. Long-term functional outcome after ileal pouch anal anastomosis in 191 patients with ulcerative colitis. J Crohns Colitis. 2014;8(10):1261–1266. 3. Tulchinsky H, Dotan I, Halpern Z, Klausner JM, Rabau M. A longitudinal study of quality of life and functional outcome of patients with ulcerative colitis after proctocolectomy with ileal pouch-anal anastomosis. Dis Colon Rectum. 2010;53(6):866–873. 4. Lepistö A, Luukkonen P, Järvinen HJ. Cumulative failure rate of ileal pouch-anal anastomosis and quality of life after failure. Dis Colon Rectum. 2002;45(10):1289–1294. 5. Pardi DS, Shen B. Endoscopy in the management of patients after ileal pouch surgery for ulcerative colitis. Endoscopy. 2008;40(6):529–533. 6. Shen B. Pouchitis: what every gastroenterologist needs to know. Clin Gastroenterol Hepatol. 2013;11(12):1538–1549. 7. Samaan MA, de Jong D, Sahami S, et al. Incidence and Severity of Prepouch Ileitis. Inflamm Bowel Dis. 2016;22(3):662–668. 8. Mclaughlin SD, Clark SK, Bell AJ, Tekkis PP, Ciclitira PJ, Nicholls RJ. Incidence and short-term implications of prepouch ileitis following restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. Dis Colon Rectum. 2009;52(5):879–883. 9. Bell AJ, Price AB, Forbes A, Ciclitira PJ, Groves C, Nicholls RJ. Pre-pouch ileitis: a disease of the ileum in ulcerative colitis after restorative proctocolectomy. Colorectal Dis. 2006;8(5):402–410. 10. Segal JP, Ding NS, Worley G, et al. Systematic review with meta-analysis: the management of chronic refractory pouchitis with an evidence-based treatment algorithm. Aliment Pharmacol Ther. 2017;45(5):581–592. 11. Segal JP, Mclaughlin SD, Faiz OD, Hart AL, Clark SK. Incidence and long-term implications of prepouch ileitis: an observational study. Dis Colon Rectum. 2018;61(4):472–475. 12. Rottoli M, Vallicelli C, Bigonzi E, et al. Prepouch ileitis after ileal pouch-anal anastomosis: patterns of presentation and risk factors for failure of treatment. J Crohns Colitis. 2018;12(3):273–279. 13. Colombel JF, Ricart E, Loftus EV, et al. Management of Crohn's disease of the ileoanal pouch with infliximab. Am J Gastroenterol. 2003;98(10):2239–2244. 14. Shen B, Remzi FH, Lavery IC, et al. Administration of adalimumab in the treatment of Crohn's disease of the ileal pouch. Aliment Pharmacol Ther. 2009;29(5):519–526. 15. Ferrante M, D'Haens G, Dewit O, et al. Efficacy of infliximab in refractory pouchitis and Crohn's disease-related complications of the pouch: a Belgian case series. Inflamm Bowel Dis. 2010;16(2):243–249. 16. Lightner AL, Pemberton JH, Loftus EJ. Crohn's Disease of the Ileoanal Pouch. Inflamm Bowel Dis. 2016;22(6):1502–1508. 17. Sandborn WJ, Tremaine WJ, Batts KP, Pemberton JH, Phillips SF. Pouchitis after ileal pouch-anal anastomosis: a Pouchitis Disease Activity Index. Mayo Clin Proc. 1994;69(5):409–415. 18. Segal JP, Ding NS, Worley G, et al. Systematic review with meta-analysis: the management of chronic refractory pouchitis with an evidence-based treatment algorithm. Aliment Pharmacol Ther. 2017;45(5):581–592. 19. Segal JP, Mclaughlin SD, Faiz OD, Hart AL, Clark SK. Incidence and long-term implications of prepouch ileitis: an observational study. Dis Colon Rectum. 2018;61(4):472–475. 20. Reinisch W, Sandborn WJ, Hommes DW, et al. Adalimumab for induction of clinical remission in moderately to severely active ulcerative colitis: results of a randomised controlled trial. Gut. 2011;60(6):780–787. [ABSTRACT FROM AUTHOR]

A child's disability, long-term illness, or mental ill-health is known to affect siblings' health, social life, school engagement, and quality of life. This article addresses a research gap by its focus on young sibling carers and the impact of providing care to a sibling. A cross-national survey study was conducted in 2018–2019 (Italy, the Netherlands, Slovenia, Sweden, Switzerland, the UK) to examine the incidence of adolescent sibling carers, the extent of care they provide, and their self-reported health, well-being, and school situation. The survey was completed by 7146 adolescents, aged 15–17, and 1444 of them provided care to family members with health-related conditions. Out of these, 286 were identified as Sibling Carers and 668 as Parent Carers, while 181 had both sibling(s) and parent(s) with health-related conditions, and thus were identified as Sibling–Parent Carers. Sibling Carers and Sibling–Parent Carers carried out higher levels of caring activities compared to Parent Carers. They reported both positive aspects of caring, such as increased maturity, and negative aspects, such as mental ill-health, impact on schooling and a lack of support. To reduce the negative aspects of a sibling carer role, it is important to recognise them and to implement early preventive measures and formal support. [ABSTRACT FROM AUTHOR]

Diurnal variations in indicators of emotion have been reliably observed in Twitter content, but confirmation of their circadian nature has not been possible due to the many confounding factors present in the data. We report on correlations between those indicators in Twitter content obtained from 9 cities of Italy and 54 cities in the United Kingdom, sampled hourly at the time of the 2020 national lockdowns. This experimental setting aims at minimizing synchronization effects related to television, eating habits, or other cultural factors. This correlation supports a circadian origin for these diurnal variations, although it does not exclude the possibility that similar zeitgebers exist in both countries including during lockdowns. [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement (PPI) is a critical priority in research, policy, academia and advocacy organizations. PPI in dementia research is gaining momentum. However, these efforts are missing in international projects aimed at those living with advanced dementia in long‐term care (LTC) homes. Additional complexities can arise in enacting PPI within the context of integration of a palliative approach to care and experiences around end‐of‐life in (EOL) dementia. The mySupport study involved implementing the Family Carer Decision Support (FCDS) intervention for care partners of those living with advanced dementia in LTC in six countries. Research Design and Objective: An interpretive description study was conducted to explore the perspectives of international researchers from six countries on engaging people with lived experiences of dementia and EOL care in research processes. The findings from this study informed the development of a PPI strategy and a subsequent toolkit for the FCDS intervention. Findings: Thirty‐eight interviews were completed with project researchers: 12 from the United Kingdom, 8 from Canada, 7 from Ireland, 4 each from Italy and The Netherlands and 3 from the Czech Republic. Four broad themes describe international researchers' perspectives on advancing methods of engagement for people with lived experiences of dementia and EOL in international PPI activities: (1) Groundwork to engage in research; (2) planning for research activities is key; (3) focus on meaningful engagement and (4) having foresight for practical issues shaping PPI. Discussion and Implications: International projects that involve PPI can present many sources of challenges. The findings in this study highlight important considerations for foundational work for incorporating PPI in international projects. Learning from world leaders and those with lived experiences in various regions can be insightful and help share tools and resources. Patient or Public Contribution: PPI was envisioned as a critical part of conducting the mySupport study. The findings from this study informed the development of a PPI strategy and an international Strategic Guiding Council that included family carers of those living with advanced dementia in LTC homes in six countries. This manuscript focused on the perspectives of researchers on their engagement with people with lived experiences of dementia and EOL. The perspectives of persons with lived experiences on engaging in the mySupport research study will be reported in a forthcoming manuscript. [ABSTRACT FROM AUTHOR]

ABSTRACT European labour markets have undergone several important innovations over the last three decades. Most countries have reformed their labour markets since the mid-1990s, with the liberalization of fixed-term contracts and temporary work agencies being the common elements to such reforms. This paper investigates the existence of a change in the dynamic behaviour of the aggregate employment for major European Union countries - France, Germany, Italy and Spain. According to our results, partial labour market reforms have made the response of the aggregate employment to output shocks larger and quite comparable to that found for the UK - the most flexible labour market in Europe since the Thatcher reforms. [ABSTRACT FROM AUTHOR]

Background: The illicit tobacco trade results in huge losses of revenue to governments, estimated at $US40-50 billion in 2006, and in increased consumption and thus health problems because it makes tobacco available more cheaply. On 20 October 2008 the second meeting of the International Negotiating Body (INB2) on the illicit trade protocol of WHO's Framework Convention on Tobacco Control (FCTC) will discuss measures to tackle the illicit trade in tobacco products. Methods: This paper presents the experience over the last decade of three countries, Italy, Spain and the United Kingdom, which shows that tobacco smuggling can be successfully tackled. Conclusion: The evidence strongly suggests that the key to controlling smuggling is controlling the supply chain, and that the supply chain is controlled to a great extent by the tobacco industry. [ABSTRACT FROM AUTHOR]

If Strategic Environmental Assessment (SEA) is to develop into an effective decision support instrument globally, then it should not just rely only on the input provided by a selected group of countries. In this context, the understanding of how to apply SEA effectively in different planning systems is unlikely to improve if the knowledge about those systems is limited. This paper establishes what appears to make SEA effective in two countries with different planning systems: Italy and the UK. Italy is chosen as an example, representing a specific Southern-European planning culture, which to date has not contributed to the SEA literature to any great extent. Based on empirical observations, it is suggested that the SEA effectiveness elements portrayed in the international literature are not fully valid. The UK is chosen as an example, which represents a specific Northern-European planning culture. Countries representing this planning culture have contributed heavily to the international SEA literature and have influenced the development of SEA theory strongly. In this context, the SEA effectiveness elements and benefits portrayed in the international literature appear to be valid. As part of a PhD research project, this paper builds on the findings of a content analysis of the international SEA literature (Fischer and Gazzola, 2006). [ABSTRACT FROM AUTHOR]

Current discussion in Europe focuses closely on (partial) labour market de-regulation as a means to combat constantly high (youth) unemployment. The paper argues that this perspective is too narrow and fails to account for existing national institutional differences. It suggests that the focus should instead be on a combination of different institutional settings, rather than on single aspects. This general issue is approached by investigating the labour market entry process and its determinants in three European countries: West Germany, Italy and Great Britain. These countries differ substantially in their combinations of relevant institutional aspects: labour market regulation, and the education and training systems. Consequently, they display three distinct patterns of labour market entry. Great Britain is characterised by rapid but rather unstable market entry, whilst market entry in Germany is also rapid but relatively stable. The main problems exist in Italy, where first job searches are very protracted. However, once jobs have been found, they are rather stable. Despite substantial deregulation efforts in Italy over the past decade, this situation has changed little. [ABSTRACT FROM AUTHOR]

The thesis of this paper is that governments of some otherwise enlightened states are increasingly fearful of acknowledging the restraints imposed on them by existing international law. They are also reluctant to enter into new commitments by way of international conventions that would expand the reach of international law. The paper asks whether these fears are based on a true understanding of international law or on some distorted view of it. It will draw comparisons and some contrasts between Australia and the United States in their reactions to a number of recent events as well as to some enduring situations of contemporary relevance. Had time (and the limits of my research) permitted, one might also have examined public attitudes toward international law in China, Japan, and Russia in this context, where similar fears appear to be entertained. France, Germany, Italy, and the United Kingdom, also enlightened states, appear by contrast to belong to a group more dedicated to international law. As Robert Kagan has recently remarked, the experience of two world wars at close quarters, and the formation of the European Union, have made the European countries more dedicated to process, where the United States is more interested in results. [ABSTRACT FROM AUTHOR]

Although the health care systems in Europe are considered the global benchmark, European nations were severely affected by the coronavirus disease 2019 (COVID-19) pandemic. This manuscript aimed to examine the strategies implemented to combat the COVID-19 pandemic by France, the United Kingdom, Spain, Italy, Germany, and Russia and their outcomes in terms of the number of cases, testing, and deaths. This is the first review of its kind that extensively analyzes the preparedness, mitigation, and response strategies against the COVID-19 pandemic adopted by these nations. This paper further suggests a strategic preparedness model for future pandemics. From the analysis, we found that a decentralized approach, prompt decision-making and timely execution, coordination between local health authorities, and public participation in the implementation of strategies could substantially reduce the case fatality rate. Nations with a high percentage of gross domestic product invested in the health sector, as well as more nurses, physicians, hospital beds, intensive care unit beds, and ventilators, better managed the pandemic. Instead, nations that postponed their pandemic response by delaying tracking, tracing, testing, quarantine, and lockdown were badly affected. The lessons learned from the present pandemic could be used as a guide to prepare for further pandemics. [ABSTRACT FROM AUTHOR]

Associating ideas related to cultural geographies of ‘quality’ food production and consumption with recent discussion of Internet technologies, virtuality and simulation, this paper examines two newly constituted Internet enterprises offering customers ‘virtual’ experiences of food production, and ‘quality’ food products in which they have invested. The paper shows how these enterprises are associated with particular types of geographical and ethical relation, and a search for ‘authentic’, connected, relationships with food, farming, locality and ‘nature’. These relationships are constituted in an assemblage of things held together by flows of food, products, money and electronic communication. The paper ends by suggesting a number of theoretical ideas that might usefully be explored in empirical research into Internet-mediated food production. [ABSTRACT FROM AUTHOR]