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Streptococcus suis, a zoonotic bacterial pathogen circulated through swine, can cause severe infections in humans. Because human S. suis infections are not notifiable in most countries, incidence is underestimated. We aimed to increase insight into the molecular epidemiology of human S. suis infections in Europe. To procure data, we surveyed 7 reference laboratories and performed a systematic review of the scientific literature. We identified 236 cases of human S. suis infection from those sources and an additional 87 by scanning gray literature. We performed whole-genome sequencing to type 46 zoonotic S. suis isolates and combined them with 28 publicly available genomes in a core-genome phylogeny. Clonal complex (CC) 1 isolates accounted for 87% of typed human infections; CC20, CC25, CC87, and CC94 also caused infections. Emergence of diverse zoonotic clades and notable severity of illness in humans support classifying S. suis infection as a notifiable condition. [ABSTRACT FROM AUTHOR]

Mucormycosis is a severe complication in critically ill COVID-19 patients. Throughout the pandemic, a notable prevalence of mucormycosis has been observed in the Indian population, whereas lower occurrences have been reported in Europe. However, limited data exist regarding its prevalence in Europe, which is potentially underestimated due to the low sensitivity of bronchoalveolar lavage (BAL) cultures. We aimed to evaluate the prevalence of mucormycosis in a high-risk critically ill COVID-19 population in the Netherlands, and to evaluate the potential benefit of adding Mucor PCR to BAL as part of routine follow-up. In this study, we included 1035 critically ill COVID-19 patients admitted to either one of the two ICUs at AmsterdamUMC between March 2020 and May 2022; of these, 374 had undergone at least one bronchoscopy. Following the AmsterdamUMC protocols, bronchoscopies were conducted weekly until clinical improvement was achieved. We cultured BAL fluid for fungi and used PCR and galactomannan testing to detect Aspergillus spp. Additionally, we retrospectively performed qPCR targeting Mucorales DNA in the BAL of 89 deceased patients. All cultures were negative for Mucorales, whereas 42 (11%) cultures were positive for Aspergillus. Furthermore, qPCR targeting Mucorales was negative in all 89 deceased patients. This study showed that pulmonary mucormycosis was not present in critically ill COVID-19 patients in two tertiary care ICUs. These results indicate routine Mucorales qPCR screening is not clinically necessary in a high-standard-of-care tertiary ICU in a low-endemic area. [ABSTRACT FROM AUTHOR]

Self-ageism has a significant negative impact on older people's ageing experiences and health outcomes. Despite ample evidence on cross-cultural ageism, studies have rarely looked into the way cultural contexts affect self-ageism. In this article, we compare expressions of self-ageism and its possible predictors across four European countries based on two questionnaires in a study sample of 2,494 individuals aged 55 and older. We explore how predictors of self-ageism are moderated by cultural values in a comparative fixed-effects regression model. We empirically show that similarly to ageism, self-ageism is not present in the same way and to the same extent in every country. Moreover, the level to which cultures value hierarchy and intellectual autonomy significantly moderates the association between self-ageism and individual predictors of self-ageism. Our study adds to the small existing body of work on self-ageism by confirming empirically that certain expressions of self-ageism and individual predictors are susceptible to change in different cultural contexts. Our research results suggest that self-ageism interventions may benefit from a culturally sensitive approach and imply that more culturally diverse comparisons of self-ageism are necessary to figure out fitting ways to reduce self-ageism. [ABSTRACT FROM AUTHOR]

This article explores the link between radicalization patterns and modes of attack planning and preparation among lone-actor terrorists. Building on theorized patterns of lone-actor radicalization, we discuss and compare their modes of pre-attack behavior, including target and weapon choice, observance of operational security measures, likeliness of engaging in leakage behavior, and the overall amount of time devoted to these activities. This exploratory study builds upon a dataset of thirty-three lone-actor terrorist cases in North-America and Europe between 1986 and 2015. The analysis suggests that specific patterns of radicalization are linked to systematic differences in modes of attack planning and preparation. The results provide insights into the heterogeneity of terrorist involvement and tentatively suggest the potential importance for law-enforcement agencies in using case-specific knowledge on radicalization patterns to inform forecasts of likely pre-attack behaviors. [ABSTRACT FROM AUTHOR]

This article empirically assesses the applicability of structural-level hypotheses for involvement in terrorism within the context of European homegrown jihadism. It uses these hypotheses to study how structural factors influenced involvement in the Dutch “Hofstadgroup.” Structural factorsenabledthe group’s emergence and its participants’ adoption of extremist views. They alsomotivatedinvolvement in political violence and a shift in some participants’ focus from joining Islamist insurgents overseas to committing terrorism in the Netherlands. Finally, structural factorsprecipitatedan actual terrorist attack. No support is found for the frequently encountered argument that discrimination and exclusion drive involvement in European homegrown jihadism. Instead, geopolitical grievances were prime drivers of this process. [ABSTRACT FROM PUBLISHER]

In this article, we propose an action research approach to capture and act upon the delights and frustrations of panel members who participate in living lab research in order to optimize the operations of the living lab itself. We used this approach to test the effectiveness of action research in providing guidelines to practitioners to evaluate and design effective and sustainable user involvement processes in living labs. We conducted a focused literature review and an in-depth case study of both the integration of a researcher within the community and the implementation of an action research project within an existing living lab. This living lab is regarded as both a forerunner and a best-practice example in Europe. Based on our findings, we recommend co-creating the "operations" of a living lab with the users themselves following a combined action research and living lab approach. [ABSTRACT FROM AUTHOR]

The aim of the Speak up! study is to increase our knowledge of European children in vulnerable situations or with special needs, and their own views about their rights and what needs to be improved. The methodology was to play a children's rights game and to hold in-depth discussions about children's rights in focus groups with children in vulnerable situations and in control groups. The qualitative study of children took place in eight European countries. Children, particularly children in vulnerable situations or with special needs, are insufficiently aware of their rights. Children living in vulnerable situations have very little experience of being listened to. They face discrimination due to disability, ethnic background or social disadvantage, and also due to being under 18-years-old. This study concludes that children in vulnerable situations or with special needs should not be viewed as passive victims but as social actors with the right to be listened to. [ABSTRACT FROM AUTHOR]

Since its enactment in 2000, the European Orphan Medicinal Products Regulation has allowed the review and approval of approaching 70 treatments for some 55 different conditions in Europe. Success does not come without a price, however. Many of these so-called "orphan drugs" have higher price points than treatments for more common diseases. This has been raising debate as to whether the treatments are worth it, which, in turn risks blocking patient access to treatment. To date, orphan drugs have only accounted for a small percentage of the overall drug budget. It would appear that, with increasing numbers of orphan drugs, governments are concerned about the future budget impact and their cost-effectiveness in comparison with other healthcare interventions. Orphan drugs are under the spotlight, something that is likely to continue as the economic crisis in Europe takes hold and governments respond with austerity measures that include cuts to healthcare expenditures. Formally and informally, governments are looking at how they are going to handle orphan drugs in the future. Collaborative proposals between EU governments to better understand the value of orphan drugs are under consideration. In recent years there has been increasing criticism of behaviours in the orphan drug field, mainly centring on two key perceptions of the system: the high prices of orphan drugs and their inability to meet standard cost-effectiveness thresholds; and the construct of the system itself, which allows companies to gain the benefits that accrue from being badged as an orphan drug. The authors hypothesise that, by examining these criticisms individually, one might be able to turn these different "behaviours" into criteria for the creation of a system to evaluate new orphan drugs coming onto the market. It has been acknowledged that standard methodologies for Health Technology Assessments (HTA) will need to be tailored to take into account the specificities of orphan drugs given that the higher price-points claimed by orphan drugs are unlikely to meet current cost-effectiveness thresholds. The authors propose the development of a new assessment system based on several evaluation criteria, which would serve as a tool for Member State governments to evaluate each new orphan drug at the time of pricing and reimbursement. These should include rarity, disease severity, the availability of other alternatives (level of unmet medical need), the level of impact on the condition that the new treatment offers, whether the product can be used in one or more indications, the level of research undertaken by the developer, together with other factors, such as manufacturing complexity and follow-up measures required by regulatory or other authorities. This will allow governments to value an orphan drug that fulfilled all the criteria very differently from one that only met some of them. An individual country could determine the (monetary) value that it places on each of the different criteria, according to societal preferences, the national healthcare system and the resources at its disposal -- each individual government deciding on the weighting attributed to each of the criteria in question, based on what each individual society values most. Such a systematic and transparent system will help frame a more structured dialogue between manufacturers and payers, with the involvement of the treating physicians and the patients; and foster a more certain environment to stimulate continued investment in the field. A new approach could also offer pricing and reimbursement decision-makers a tool to handle the different characteristics amongst new orphan drugs and to redistribute the national budgets in accordance with the outcome of a differentiated assessment. The authors believe that this could, therefore, facilitate the approach for all stakeholders. [ABSTRACT FROM AUTHOR]

Objective To compare early and late responses to highly active antiretroviral therapy (HAART) in European and non-European HIV-1 infected patients in a Dutch cohort. Methods We retrospectively analysed the response to HAART of 216 previously treatment-naive HIV-1-infected patients using the University Medical Centre Utrecht HIV database. African ( n=51), Asian ( n=7), and Central/South American ( n=6) patients were classified as non-European, and others as European ( n=152). Early failure was defined as a viral load that remained above 400 HIV-1 RNA copies/mL after 6 months of treatment with HAART. Late-phase failure was determined in patients who were successfully treated in the early phase and was defined as two consecutive viral load measurements above 400 copies/mL, a new AIDS-defining event or death. Results In the early phase, four of 152 (2.6%) European and eight of 64 (12.5%) non-European patients failed HAART. A significant increased risk of virological failure in the early phase of treatment was observed for non-Europeans as compared to Europeans (odds ratio 4.6; 95% confidence interval 1.1–20.2). Low serum drug levels in the absence of resistant virus were often seen at the time of early failure. No difference in late-phase failure was observed between the two groups (adjusted hazard ratio 0.6; 95% confidence interval 0.3–1.2). Conclusions Non-European patients had a 4.6 times higher risk of virological failure than their European counterparts in the first 6 months of treatment with HAART. This failure seemed to be associated with low serum drug levels at the time of failure. However, if HAART was successful in the early phase, response rates in the late phase were similar for Europeans and non-Europeans. [ABSTRACT FROM AUTHOR]